2020 DIETARY GUIDELINES ADVISORY COMMITTEE ... · (202) 234-4433 Washington DC Neal R. Gross and...

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2020 DIETARY GUIDELINES ADVISORY COMMITTEE

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PUBLIC MEETING

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FRIDAY JANUARY 24, 2020

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The Dietary Guidelines Advisory Committee met in the Agricultural Research Service, Children’s Nutrition Research Center, 1100 Bates Street, Houston, Texas, at 9:00 a.m., Barbara Schneeman, Chair, presiding. The meeting allowed for public viewing, both in-person and by webcast.

MEMBERS PRESENT DR. BARBARA SCHNEEMAN, PhD, Chair DR. RONALD KLEINMAN, MD, Vice Chair DR. JAMY ARD, MD, Member DR. REGAN BAILEY, PhD, MPH, RD, Member DR. LYDIA BAZZANO, MD, PhD, Member DR. CAROL BOUSHEY, PhD, MPH, RD, Member DR. TERESA DAVIS, PhD, Member DR. KATHRYN DEWEY, PhD, Member DR. SHARON DONOVAN, PhD, RD, Member DR. STEVEN HEYMSFIELD, MD, Member DR. HEATHER LEIDY, PhD, Member DR. RICHARD MATTES, PhD, MPH, RD, Member DR. ELIZABETH MAYER-DAVIS, PhD, RD, Member DR. TIMOTHY NAIMI, MD, MPH, Member DR. RACHEL NOVOTNY, PhD, RDN, LD, Member DR. JOAN SABATÉ, MD, DrPH, Member DR. LINDA SNETSELAAR, PhD, RD, Member DR. JAMIE STANG, PhD, MPH, RD, Member DR. ELSIE TAVERAS, MD, MPH, Member


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PUBLIC COMMENTERS: RAYMOND DeVIRGILLIS BECKY GARRISON BILL YOUNG KARIMA KENDALL BERIT DOCKTER DONALD LAYMAN SUSAN BACKUS MAIA JACK ALLIE GRAHAM SARAH REINHARDT JOY DUBOST JESSI SILVERMAN SARAH OHLHORST CHRIS JONES JONATHAN CLINTHORNE CHRISTOPHER PALMER PEPIN TUMA LINDA CARNEY LANA FRANTZEN MICHAEL DODDS NANCY ERIKSEN BROOKE GOLDNER MARTICA HEANER TONY MARTINEZ TAYLOR WALLACE BANDANA CHAWLA MUNISH CHAWLA AMY EIGES DARREN SCHMIDT TYLER HAZARD TOM BRENNA ERIN JANUS MARGARET JARDINE DIANE WELLAND MARCIA de OLIVEIRA OTTO CARY FRYE MINH NGUYEN GUY JOHNSON JENNIFER McGUIRE LARRY DIAMOND TED EYTAN DEBRA MILLER ANTHONY GUSTIN MICHELLE MULLER


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NADIR ALI DOUG REYNOLDS TIFFANY NGUYEN FARIDA MOHAMEDSHAH JACOB SMIGEL ALBERT LEAR MOLLY McADAMS


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CONTENTS

Call to Order ................................... 5 Jackie Haven, MS, RD

Opening Remarks ................................ 5 Brandon Lipps

Chair Remarks .................................. 13 Barbara Schneeman, PhD

Subcommittee Updates, Continued:

Dietary Patterns Subcommittee .................. 20 Carol Boushey, PhD, MPH, RD

Frequency of Eating Subcommittee .............. 69

Steven Heymsfield, MD

Committee Discussion .......................... 106 Facilitated by Barbara Schneeman, PhD, Chair, and Ronald Kleinman, MD, Vice Char

Public Comments ............................... 136 Facilitated by Janet de Jesus, MS, RD

Adjourn ....................................... 309


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1 P-R-O-C-E-E-D-I-N-G-S

2 9:02 a.m.

3 MS. HAVEN: Good morning. Welcome of

4 day two of the Dietary Guidelines Advisory

5 Committee meeting, live from Houston, Texas. My

6 name is Jackie Haven. I’m the deputy administrator

7 for USDA’s Center for Nutrition Policy and

8 Promotion, and it’s my pleasure to introduce the

9 Deputy Under Secretary for USDA’s Food, Nutrition

10 and Consumer Services, Brandon Lipps.

11 It’s my pleasure to introduce him, and

12 just for background, FNCS, Food, Nutrition and

13 Consumer Services, works in hunger and to improve

14 the health of the U.S. as it administers federal

15 domestic nutrition assistance programs and links

16 scientific research and nutrition needs of

17 consumers, through science-based dietary

18 guidance, nutrition policy coordination, and

19 nutrition education.

20 Mr. Lipps?

21 MR. LIPPS: Good morning.

22 AUDIENCE: Good morning.


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1 DEPUTY UNDER SECRETARY LIPPS: That

2 was good. Jackie, thanks for the kind

3 introduction. Welcome everyone to the fourth

4 meeting of the 2020 to 2025 Dietary Guidelines

5 Scientific Advisory Committee.

6 I’m here on behalf of USDA,

7 specifically, Food, Nutrition and Consumer

8 Services, and my colleague, Dr. Scott Hutchins from

9 ARS, and our partners at the Department of Health

10 and Human Services.

11 It is good to be back in my home state.

12 People regularly say to me, are you going to get

13 to see your family while you’re home? I am in my

14 home state, but I am 532 miles from home.

15 So those of you from smaller states, you

16 don’t understand, but I’m not going to see my family

17 while I’m here. Given the second opportunity for

18 the public to provide comments to the Committee,

19 it was very important to Secretary Purdue that we

20 get out of the beltway of Washington, D.C.

21 This is the first time in decades that

22 the public has had an opportunity to comment on the


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1 Dietary Guidelines outside of the work that we do

2 in the beltway in D.C. and the important decisions

3 that are informed by the work of this Committee for

4 the American public every day. We’re grateful to

5 the folks here at the Children’s National Research

6 Center for allowing us to hold this important

7 meeting here. A little background on where we are

8 in the important public-private partnership that

9 has made today possible.

10 USDA’s Agricultural Research Service

11 and the Baylor College of Medicine have had a

12 long-shared interest in public health issues. I

13 saw on your way in -- hopefully you all saw this,

14 but I brought a little prop so that we can remember

15 what the important work of the Children’s National

16 Research Center is about, the children, and they

17 have this wonderful little pin that you set on your

18 desk and wiggle.

19 It’s a good distraction from my remarks

20 this morning, so I brought it. This partnership

21 between government and the private sector is

22 another example of how combined intellectual power


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1 increases our power to address and potentially

2 solve important nutritional challenges.

3 Thank you again to Children’s National

4 Medical Center, Dr. Bier and his colleagues at the

5 Baylor University College of Medicine, for hosting

6 us today and for being a willing partner and

7 allowing the Committee to again hear from the

8 American public.

9 Can the webcast hear this microphone

10 okay? Okay. Good.

11 We’re also happy to see professionals

12 and students from the Texas Medical Center and the

13 greater Houston area registered for the meeting

14 today.

15 Thank you to each of you for joining us.

16 To the medical students here today, I hope that you

17 are impressed both by the time and effort that this

18 Committee has put forward to help inform the

19 significant government policy and the importance

20 of your participation in the formation of

21 government policy as your career progresses.

22 Last night I had the opportunity to


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1 visit with a student who traveled here today to

2 watch the important work of this Committee. We’ll

3 need more people to get involved in the public

4 policymaking process earlier in their careers to

5 ensure that we have people willing to dedicate the

6 time that these wonderful individuals have as they

7 progress in their careers.

8 To the Committee -- I say this every

9 time we’re together -- you all do all of the hard

10 work; I follow you around and say, thank you, and

11 I’m here to do that again today.

12 Thank you for continuing to dedicate

13 your scientific expertise and time to the important

14 phase of reviewing the current body of evidence,

15 to answer the questions that we have asked of you.

16 As we saw yesterday, you had your hands

17 full reviewing the evidence. Your work to conduct

18 this rigorous, robust, and independent scientific

19 review is critical to informing the work of USDA

20 and HHS as we prepare for the next edition of the

21 Dietary Guidelines.

22 I also want to thank the Committee for


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1 including time to hear directly from members of the

2 public this afternoon. Past Dietary Guidelines

3 have traditionally heard in-person, oral comments

4 only once at the beginning of their scientific

5 process.

6 This is the first time that the public

7 will have an additional opportunity to provide

8 comments in person to the Dietary Guidelines

9 Advisory Committee.

10 I want to make sure that the public

11 understands that this is a volunteer Committee of

12 experts who are very busy in their professional

13 lives with very important work and have volunteered

14 their time to come help, and they all

15 overwhelmingly and happily agreed to have a second

16 in-person session to hear directly from the public.

17 They have a difficult job with a lot of

18 evidence to review. They are spending a

19 significant amount of time making sure that they’re

20 getting that right and that they are taking the

21 proper steps necessary to inform this process.

22 So with that, let’s give the Committee


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1 a round of applause for their dedication and hard

2 work.

3 (Applause.)

4 DEPUTY UNDER SECRETARY LIPPS: To the

5 folks here in Houston and those joining us by

6 webcast, thank you for your participation in our

7 multi-year process to develop the Guidelines. As

8 you continue to follow the Committee’s

9 deliberations today, I think you’ll see firsthand

10 that, as we noted, this is no small undertaking.

11 Again, I hope you’ll have an

12 appreciation for how much the Committee is putting

13 into its work to review the science to address our

14 topics and questions.

15 For those not able to provide oral

16 public comments here today, just a reminder.

17 There is an ongoing open period for public comments

18 to the Committee that started in March of last year

19 and will close when the Committee submits its

20 scientific report in May of this year to USDA and

21 HHS.

22 So don’t be shy. There’s time for you


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1 to submit written comments. We review each and

2 every one of those and provide a summary of them

3 to the Committee as they continue their work, and

4 your input and participation is important to this

5 process.

6 Again, I cannot thank the Committee

7 enough for their work on this very important

8 process and for their willingness to travel to

9 Houston to meet today. We are excited to be here

10 in Houston with you all.

11 Before I turn the meeting over to begin

12 their important work, I want to take a moment to

13 pause and thank my colleagues at USDA and our

14 colleagues at the Department of Health and Human

15 Services for their tireless work in support of this

16 Committee.

17 Every time I have a chance to interact

18 with the Committee, the first thing they say to me

19 is hello. The second thing they say is, I want to

20 tell you how wonderful the staff at CNPP and ODPHP

21 are in support of what we have to do in the big task

22 that we have.


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1 I know that. I get the wonderful

2 opportunity to work with these individuals on a

3 daily basis. But I know the work that they’re

4 putting in in support of the Committee, and I

5 appreciate your recognition for that.

6 If you are staff in support of this

7 process, would you stand and let us give you a round

8 of applause, please? Jackie?

9 (Applause.)

10 DEPUTY UNDER SECRETARY LIPPS: With

11 that, we will get on with the work of day two, and

12 I will now turn it over to the Chair of the 2020

13 Dietary Guidelines Advisory Committee, Dr. Barbara

14 Schneeman, to get day two started.

15 Thank you.

16 (Applause.)

17 CHAIR SCHNEEMAN: Great. Thank you so

18 much for those comments, and again, on behalf of

19 the Committee, we also extend our appreciation to

20 the Children’s Nutrition Research Center, the ARS

21 Center here, for hosting this meeting, and we’ll

22 echo the wonderful staff support and how much we


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1 appreciate the staff support for the work that is

2 being done.

3 So I’m going to just go through a few

4 slides to get us started with today’s meeting. So

5 again, we want to just describe the status and

6 provide updates on the work of the Committee up to

7 this point, and we had draft conclusions for

8 approximately 30 questions that are being

9 presented during this two-day meeting, including

10 the NESR systematic reviews and data analysis.

11 And these draft conclusions have been

12 drafted by the subcommittee and then are being

13 brought to the full Committee for discussion at the

14 public meeting. Those systematic review

15 conclusions will be posted online after going

16 through peer review, and again, I remind you that

17 they are considered draft until the Committee

18 submits its report to the Secretaries.

19 And I thought it would be worthwhile to

20 just also comment that I think, as we are looking

21 at what was presented yesterday and what we’ll be

22 seeing today, we’re primarily focused on summaries


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1 of the evidence that the subcommittees have been

2 working on.

3 And I think in some of the reports

4 yesterday, you began to see a little bit of a hint

5 of the detail that the subcommittees are working

6 at in terms of how closely they look at the nature

7 of the studies that come forward, the study design,

8 the interpretation, the confounders.

9 I think in the Beverage and Added Sugar

10 subcommittee report, you were beginning to see some

11 of that detail that the committees actually look

12 at it.

13 So while we’re focused on the summaries

14 here, the evidence portfolios that are available

15 to the Committee are very detailed, and all of that

16 information eventually becomes part of the public

17 record, as we keep moving through the process.

18 So yesterday, we had the subcommittee

19 reports from the Birth to 24 Months, Pregnancy and

20 Lactation, Dietary Fats and Seafood, Beverages and

21 Added Sugar, Data Analysis and Food Pattern

22 Modeling, and I think, a very useful Committee


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1 discussion about not only each of those reports,

2 but then how the Committee is beginning to see the

3 relationship between these different areas of

4 work.

5 And today, after these opening remarks,

6 we’ll be hearing from the subcommittee on Dietary

7 Patterns, and the Frequency of Eating

8 subcommittee. And again, each of those will be

9 followed by some Committee discussion.

10 And we also then are looking forward to

11 the public comments, and again, let me just note

12 that the comments have been useful to the

13 Departments, HHS and USDA, and useful to the

14 Committee in its work.

15 Many of you who have been following the

16 process know that the website gives the status of

17 our work, and that’s a new part of the website to

18 not only just tell you about the Dietary

19 Guidelines, but to track the work that the

20 Committee is actually doing, plus it provides a lot

21 of information on the process, the ways that the

22 Committee is in fact evaluating the information.


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1 The Departments do continue to update

2 the information on that website, not only sort of

3 the protocols and where we are, but also updating

4 the frequently asked questions section. So that

5 way, they can clarify the approach that the

6 Committee -- for example, I know that there have

7 been some updates to provide more information on

8 our process for evaluating evidence, the data

9 analysis, the systematic reviews, and the food

10 pattern modeling, just to make sure that the way

11 the Committee is working through is clear to the

12 public, as we move forward.

13 So I encourage you to either be on the

14 listserv for the Dietary Guidelines as a way to get

15 notices as updates happen, but also just check that

16 website and particularly look at that FAQ section,

17 if you have some particular questions in your own

18 mind about the approaches that we’re using. You

19 can find some more information.

20 So a note on our timing today. Again,

21 our afternoon session will begin at 1:00 p.m.

22 Central Time, and we really try to hold clear to


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1 that time because of the webcast.

2 Our breaks during the morning and

3 afternoon sessions are not set for a specific time,

4 but will be taken as they fit within our discussion.

5 And our public comments will begin no later than

6 2:00 p.m. Central Time, but they may begin earlier

7 if we’re ready to start that process. So hopefully

8 if you’re giving a public comment, you’ll be here

9 before two, just in case.

10 So again, this is the website for the

11 DietaryGuidelines.gov, and as Eve did, Dr. Stoody

12 did yesterday, we’ve highlighted the place where

13 you can view the protocols, with that reminder

14 that, for the protocols presented, it’s most useful

15 to us if you have any comments you might provide

16 by February 7.

17 But I would also note, given where we

18 are in the process, where the March meeting is

19 really the last decision-making meeting for the

20 Committee, the last public meeting where we’ll be

21 getting subcommittee reports, feel free to get

22 comments to us if you have comments about our


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1 conclusion statements or other aspects of what the

2 Committee is working on by that February 7 date,

3 to be most useful in our decision-making process.

4 But as noted by Mr. Lipps and others,

5 the comment period is open until the Committee

6 concludes its work. So with that, I think we will

7 start with our agenda for the subcommittees.

8 I want to check with the Committee

9 members if you have any questions or comments at

10 this point? Jamy, please?

11 MEMBER ARD: Jamy Ard. So just as a

12 point of process, would it be okay for us to

13 interrupt presentations with questions today? Is

14 that okay for discussion? Or I don’t know if it’s

15 more efficient to let --

16 CHAIR SCHNEEMAN: Yes. It’s --

17 MEMBER ARD: -- people go through the

18 entire presentation and then do what we have done,

19 but I --

20 CHAIR SCHNEEMAN: I think we -- I’ll

21 let each subcommittee chair sort of address that

22 at the beginning, if they’re comfortable with


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1 having that approach. So we have the two

2 subcommittees, so we’ll just them say whether

3 they’re comfortable with that.

4 (Pause for conference.)

5 CHAIR SCHNEEMAN: Right, it might be

6 useful. Well, let me just check before we jump

7 into -- anybody else, question or comment? Okay.

8 Oh, okay, so both are fine with that. So -- okay.

9 So -- all right.

10 (Pause for conference.)

11 MEMBER BOUSHEY: Good morning again.

12 Because I think you said good morning, too. And

13 so my name is Carol Boushey, and you can see on this

14 list, they’re members of the Dietary Patterns

15 subcommittee.

16 And I think this is the largest

17 committee in numbers and maybe has to do with -- we

18 do have a lot of work to review, because this area

19 of dietary patterns has really exploded since the

20 last Dietary Guidelines Advisory Committee.

21 So the NESR staff, they’ve been

22 screening articles, preparing evidence


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1 portfolios, and they’ve been screening -- screened

2 approximately 113,000 articles from the electronic

3 search results for questions dietary patterns and

4 sarcopenia, all-cause mortality, and a combined

5 search for the questions related to growth, size

6 and body composition, type 2 diabetes, and

7 cardiovascular disease.

8 In addition, the NESR staff has

9 extracted data and assessed risk of bias for more

10 than 190 articles and additional extraction is

11 underway. Today the subcommittee will present the

12 evidence and draft conclusion for the dietary

13 patterns and all-cause mortality.

14 The subcommittee is also refining and

15 prioritizing its remaining work for the questions

16 related to dietary patterns and sarcopenia,

17 cancer, neurocognitive health, and bone health,

18 which will be discussed in more detail at the end

19 of this presentation.

20 So our key definitions -- and so you’ve

21 seen this before. Many people have seen this

22 before. But the key definitions that we’re using


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1 for dietary patterns are the quantities,

2 proportions, variety or combination of different

3 foods, drinks and nutrients, when available, in

4 diets and the frequency with which they are

5 habitually consumed.

6 This key definition came from -- oh,

7 apparently, we didn’t put that in this time. Okay.

8 All information provided by studies about

9 diet -- it came from an international statement.

10 So this wasn’t created just for this,

11 and so it is internationally recognized as the

12 definition for dietary patterns.

13 All information provided by studies

14 about dietary patterns tested or examined,

15 including both foods and beverages, macro- and

16 micronutrients will be extracted from included

17 articles.

18 And that macro- and micronutrients,

19 that was added as a result of comments from

20 individuals outside of the Dietary Guidelines

21 Committee. The comments were received; we added

22 in that component within the dietary patterns.


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1 Based on conversations at the last

2 committee meeting and misconceptions among the

3 public and media, the SC refined the intervention

4 exposure criteria for the intervention exposure to

5 clarify how the subcommittee will consider dietary

6 patterns, as well as diets based on macronutrient

7 distribution and how they may or may not relate to

8 each other.

9 For the first time, the subcommittee is

10 considering diets based on macronutrient

11 distribution where at least one

12 macronutrient -- that is either carbohydrate, fat

13 and/or protein -- is outside the acceptable

14 macronutrient distribution range, or its also

15 known AMDR, set by the National Academies of

16 Science.

17 For example, any study in which

18 carbohydrate intake is above or below the AMDR,

19 greater than 65 percent of energy or below

20 45 percent of energy that also meets the

21 inclusion/exclusion criteria provided in the

22 protocol will be examined to answer the questions.


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1 This approach allows the committee to

2 systematically review the overall scientific

3 landscape of dietary patterns, including patterns

4 that are both within and outside the AMDR, along

5 with different diet types.

6 So the question that will be reviewed

7 today, we’ll be presenting the findings from the

8 systematic review question related to dietary

9 patterns consumed and all-cause mortality. The

10 approach to answer this question is a NESR

11 systematic review.

12 You’ve seen quite a few analytic

13 frameworks, and the analytic framework provides a

14 foundation for the systematic review and helps to

15 inform the approach for this question. The

16 subcommittee defines all-cause mortality as the

17 total number of deaths from all causes during a

18 specific time period.

19 The exposure of interest is the

20 consumption of and/or adherence to a dietary

21 pattern. The comparators are consumption of

22 and/or adherence to a different dietary pattern and


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1 different levels of consumption and/or adherence

2 to the dietary pattern.

3 The population of interest for the

4 exposure and outcome include children through

5 older adults who are healthy and/or at risk for

6 chronic disease. For this question, the

7 subcommittee decided that infants and toddlers

8 from birth to 24 months were out of the scope.

9 The key confounders are listed on this

10 slide, and within the body of evidence the

11 subcommittee reviewed, the majority of studies

12 accounted for these factors. This slide

13 illustrates the literature search and screening

14 results for articles examining the dietary

15 patterns and all-cause mortality.

16 The results of the electronic database

17 searches, after removal of duplicates, were

18 screened independently by two NESR analysts using

19 a stepwise process by reviewing titles, abstracts,

20 and full text to determine which articles met the

21 inclusion criteria.

22 For this review, 11,547 articles titles


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1 were searched, 1,693 articles were

2 abstract-screened, and 554 articles were screened

3 at the full text level. A manual search was done

4 to find articles that were not identified when

5 searching the electronic databases.

6 All manually identified articles are

7 also screened to determine whether they met the

8 criteria for inclusion. For this review, no

9 articles were identified during the manual search.

10 The review resulted in 152 included

11 articles. The 152 articles in this review are all

12 prospective cohort study designs. An aside there:

13 we’re kind of glad about that. We hope that no one

14 ever does a randomized trial that the endpoint is

15 death.

16 So in some ways, this is something to

17 be very grateful for. They examined the

18 relationship between dietary patterns and

19 all-cause mortality. The studies used multiple

20 approaches to assess dietary patterns.

21 105 articles used only index or score

22 analysis to examine the relationship between


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1 dietary patterns or diets based on macronutrient

2 distribution and all-cause mortality.

3 Eighteen articles examined the

4 relationship between dietary patterns with factor

5 and cluster analysis and/or diets based on

6 macronutrient distribution; 27 articles examined

7 the relationship between diets based on

8 macronutrient distributions.

9 Of the remaining 15 articles, six

10 articles used multiple methods, including both

11 index analysis and factor analysis, or factor

12 analysis and reduced rate regression, or just

13 reduced rate regression was used for comparison.

14 Of the 27 articles that evaluated

15 macronutrient distribution, 15 articles also used

16 another approach to examine dietary patterns.

17 Despite the variety of different methods applied

18 to examine or derive dietary patterns, there was

19 remarkable consistency in the majority of the

20 studies finding statistically significant

21 relationships between dietary patterns consumed

22 and all-cause mortality.


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1 Although the dietary patterns were

2 characterized by different combinations of foods

3 or beverages, due to the variety of methods used,

4 protective dietary patterns emerged with the

5 following themes: patterns emphasizing higher

6 consumption of vegetables, legumes, fruits, nuts,

7 whole grain, fish, lean meat or poultry, and

8 unsaturated fats relative to saturated fats,

9 either as a ratio of MUFA to saturated fat, or

10 MUFA -- PUFA to saturated fat, or olive oil

11 specifically.

12 They were generally associated with

13 decreased risk of all-cause mortality. Notably

14 there was consistency in particular with the

15 inclusion of fish and/or seafood. Of the dietary

16 patterns that included animal products, protective

17 associations were generally observed with

18 relatively lower consumption of red and processed

19 meat or meat and meat products.

20 Some of the dietary patterns also

21 included alcoholic beverages in moderation within

22 specific thresholds. The inclusion of white meat


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1 to red meat ratio, type and amount of dairy

2 products, and refined carbohydrates, sweets, as

3 elements of these patterns was less consistent

4 across the evidence.

5 Among the dietary patterns that

6 included higher consumption of white meat relative

7 to red or processed meat, low-fat dairy relative

8 to high-fat dairy, and lower relative to higher

9 refined carbohydrates and sweets tended to show

10 reduced risk of all-cause mortality.

11 Despite the variability between

12 approaches used to examine dietary patterns,

13 higher adherence to dietary patterns with common

14 labels, such as Mediterranean, Dietary

15 Guidelines-related, and also Dietary Guidelines

16 such as healthy eating index, DASH scores, or

17 plant-based guides were generally protective

18 against all-cause mortality risk.

19 This highlights that high-quality

20 dietary patterns comprised of nutrient-dense

21 foods, regardless of the label, were associated

22 with decreased all-cause mortality risk. And the


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1 next one will have a little -- where is that? Oh

2 it’s later.

3 Although all included studies were

4 prospective cohort studies, the majority of

5 articles reported adjustment for most key

6 confounders, as I had mentioned earlier, with the

7 exception to race/ethnicity.

8 Due to lack of reporting, it is

9 difficult to determine the impact that

10 race/ethnicity specifically may have in the

11 relationship between dietary patterns and

12 all-cause mortality.

13 The largest segment of evidence in this

14 systematic review used the index or score analysis

15 to assess dietary patterns. Within this segment

16 of evidence, nearly 80 different indices or scores

17 were used to assess dietary patterns, including 30

18 Mediterranean indices.

19 Now, to make that clear, it doesn’t mean

20 that the Mediterranean diet was used 30 times; it

21 was 30 different variations of the Mediterranean

22 diet, with the Mediterranean score by Trichopolou


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1 as being the most frequently used.

2 There were seven healthy eating indexes

3 that were used or the Dietary Guidelines for

4 Americans indexes. Only one DASH score, so DASH

5 was the same across the board, no matter what study

6 that used DASH.

7 Sixteen country specific indices, such

8 as the Dutch healthy diet index, and 24 other

9 indices or scales, such as the recommended food

10 score. Across all indices or scores, the

11 following items or components are generally, but

12 not exclusively, considered.

13 So this is an extensive list here, that

14 I’ll give you a few minutes to look through, or take

15 an image. And it’s important to know these were

16 not exclusive, so we can’t say that every dietary

17 pattern had one of these in there.

18 This is just a summary of the most

19 common food sources that made up the components of

20 the dietary patterns. Macronutrient

21 distributions with proportions of energy falling

22 outside of the AMDR for at least one macronutrient


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1 were examined in this body of evidence, but results

2 were not consistent.

3 Notice we have switched to summary of

4 evidence synthesis. Among these studies,

5 proportions of carbohydrate reported were both

6 below and above the AMDR. Proportions of fat

7 reported were both below and above the AMDR.

8 No studies examined macronutrient

9 distribution in which protein fell outside of the

10 AMDR.

11 Comparison of the macronutrient

12 distributions with or without the context of the

13 foods, food groups comprising the dietary patterns

14 showed inconsistent findings due to several

15 limitations.

16 The gradient between the macronutrient

17 proportions compared between distributions was

18 small: a range of 41 percent to 41.7 percent.

19 Most methods used to estimate macronutrient intake

20 differed between studies.

21 Most proportions reported were only

22 marginally outside of the AMDR, due to the variance


33

1 with which studies defined and applied limits to

2 macronutrient categories. When viewing these

3 null results, the committee reflected, looking at

4 macronutrient distribution without diet quality is

5 maybe a moot activity. That was just a reflection

6 of ours.

7 So the strong evidence suggests that

8 certain dietary patterns in adults and older adults

9 are associated with decrease risk of all-cause

10 mortality.

11 These dietary patterns were

12 characterized by intake of vegetables, legumes,

13 fruits, nuts, whole grains, fish, lean meat or

14 poultry, and unsaturated fats related to saturated

15 fats.

16 Of the dietary patterns that included

17 animal products, protective associations were

18 generally observed with relatively lower

19 consumption of red and processed meat or meat and

20 meat products.

21 Some of these dietary patterns also

22 included alcoholic beverages in moderation or


34

1 within specific thresholds. The inclusion of

2 white meat, red meat ratio, type and amount of dairy

3 products, and refined carbohydrates, sweets, as

4 elements of these patterns was less consistent

5 across the evidence.

6 However, the dietary patterns that

7 included higher consumption of white meat relative

8 to red or processed meat, low-fat dairy relative

9 to high-fat dairy, and lower relative to higher

10 refined carbohydrates and sweets tended to show

11 reduced risk of all-cause mortality.

12 Macronutrient distributions with

13 proportions of energy falling outside of the AMDR

14 were examined in this body of evidence, but results

15 were inconsistent. And insufficient evidence was

16 available to determine the relationship between

17 dietary patterns and all-cause mortality in

18 younger populations, and that’s ages less than 35

19 years.

20 Coming next -- and I should mention on

21 that last slide, you have been used to seeing all

22 these different grades; the evidence on this was


35

1 so clear.

2 Out of all the papers that we reviewed

3 outside of the macronutrient distribution, there

4 were really only 10 papers that didn’t have

5 significant results of protection with regard to

6 dietary patterns, high-quality dietary patterns.

7 So now where we’re going is we’re

8 refining and prioritizing the remaining work. The

9 subcommittee is in the process of refining and

10 prioritizing its remaining work. This includes

11 looking at the intermediate and endpoint outcomes

12 and refining what the subcommittee will have time

13 to accomplish.

14 For example, the subcommittee has

15 decided to only look at the endpoint outcome of

16 sarcopenia and severe sarcopenia, and excluding

17 articles that only examine intermediate outcomes.

18 For the question related to cancer,

19 neurocognitive health, and bone health, the

20 subcommittee is reviewing the work of the 2015

21 Dietary Guidelines Advisory Committee and may

22 refine outcomes to align with these existing


36

1 reviews or carry forward existing work.

2 The other next steps are to complete the

3 data extraction and risk of bias assessment of

4 dietary patterns and sarcopenia. The NESR staff

5 is also in the process of screening the scientific

6 literature for questions related to dietary

7 patterns and growth, size and body composition,

8 dietary patterns in type 2 diabetes, and dietary

9 patterns in cardiovascular disease.

10 We will also develop a conceptual

11 framework to facilitate evidence synthesis based

12 on dietary patterns and their components, which may

13 include foods and beverages, food groups, and

14 macronutrient distribution in the context of diet

15 quality.

16 Thank you for listening to the summary

17 of our work to date in the Dietary Patterns

18 subcommittee. Here we have listed again the

19 members, which were on the opening slide, but also

20 the support staff, because we wouldn’t be able to

21 do any of this work without the great support staff

22 that we have from the USDA and the Department of


37

1 Health and Human Services.

2 So no one interrupted me, so why don’t

3 you do that now?

4 (Applause.)

5 MEMBER BOUSHEY: Rick. But let’s go

6 with Rick first, because he’s usually first.

7 MEMBER MATTES: You commented on the

8 consistency of the findings and noted that these

9 are 100 percent prospective cohort studies that

10 often have large sample sizes. Can you comment on

11 the effect size of the trials?

12 They may all be significant, but to what

13 degree are they meaningful? If you have big sample

14 sizes, you can find small differences

15 statistically significant. To what degree do

16 you -- does the evidence indicate --

17 MEMBER BOUSHEY: Well, you know,

18 actually not all of them were completely large,

19 Rick. That’s what’s interesting.

20 Does anyone have a -- kind of an outline

21 of what some of the ranges of samples sizes were?

22 And some of the ones that didn’t find the


38

1 significant results were smaller ones, but there

2 really were some as small as 200.

3 MEMBER MATTES: Okay.

4 MEMBER BOUSHEY: Yeah.

5 MEMBER MATTES: Nevertheless --


7 MEMBER MATTES: -- can you comment on

8 effect size, not just significance?

9 MEMBER BOUSHEY: I don’t know that I

10 can comment on it. I’d have to actually think

11 about that a bit, but that’s -- does anyone else

12 on the committee have an idea of what the effect

13 size might be? Joan?

14 MEMBER SABATÉ: Joan Sabaté. The

15 effect size did vary, and sometimes it’s just a

16 decrease in the risk of 10 percent, but sometimes

17 went up to 25 percent decrease. So this is the

18 effect size that I do remember.

19 Maybe there is a table that staff can

20 show on the screen, but I -- the effect size was

21 sometimes not very big, but you know, that’s quite

22 considerable.


39

1 MEMBER BOUSHEY: That’s good. Thank

2 you.

3 MEMBER MAYER-DAVIS: So I’m recalling

4 ratios that were around .85 to maybe .95, something

5 like that, but it did vary, and some of that was

6 a function of duration of follow-up, you know,

7 which is another issue, that, you know, varied

8 quite a bit across all of this literature.

9 And sample size did vary quite a bit.

10 I’ve actually never seen a set of data with this

11 degree of consistency. It was quite remarkable.


13 MEMBER SABATÉ: Joan Sabaté again.

14 Not only the effect size, but also some of these

15 indices -- I mean, there were different

16 categories. So there was kind of a dose response

17 effect that was quite visible, you know, in this

18 body of literature.

19 MEMBER BOUSHEY: Yeah. I really

20 cannot emphasize enough this whole idea that there

21 is no one magic bullet, but when you have

22 consistent, high-quality -- a high-quality diet it


40

1 can be achieved using multiple foods, and as long

2 as it fits within these tight guidelines of what

3 we outlined -- you know, low in certain fats, low

4 in sugar, and all of are low

5 in -- some -- controlled sodium -- it’s quite

6 remarkable.

7 MEMBER NOVOTNY: Thanks. That was

8 very interesting. It makes me reflect on the work

9 of the whole Committee, particularly those of us

10 that are looking at foods, food groups, seafood,

11 added sugars, beverages, and really, broadly at our

12 methods.

13 And it seems clear that we’re moving in

14 this direction, and a lot of our methodological

15 challenges have to do with the reality of focusing

16 on a food in the context of a very complex diet.

17 And therefore it makes me -- if we could

18 start all over again or start again or have longer,

19 the idea of basically pulling out those foods

20 within a dietary pattern or looking at the dietary

21 pattern with an emphasis on those that are high in,

22 say, added sugars or those that are high in certain


41

1 beverages or even overall beverages, those that are

2 high seafood, some way of basically looking at that

3 list of foods in the scoring and, again, defining

4 diets according to our interests.

5 I think its -- so I guess the short,

6 real question is whether any of that is still

7 possible to contribute to the other committees. I

8 know that we’re trying to tie up our work, but if

9 not, I think as a committee something to think about

10 in our recommendations is how to go forward with

11 this kind of review of literature in that

12 communication.

13 MEMBER BOUSHEY: You know, I actually

14 really -- I like that comment that you made,

15 Rachel, but I also actually like that we have these

16 other -- you know, that we’re looking at it in

17 different ways to give real affirmation.

18 I really like that, but your comment

19 about that what the foods are. Actually, Liz and

20 Laural have been working on this, and they’ve

21 created a - right now, it’s in an Excel

22 spreadsheet, and we’re trying to figure


42

1 out -- it’s massive -- so we’re trying to figure

2 out how we can condense it down to -- the best that

3 we’ve got was that one slide that you saw with all

4 the foods listed; that fit on the slide, so that

5 worked well.

6 But it is -- it’s extensive. Do you

7 want to shake your head? Yeah. And so I -- so the

8 neat thing is you’ve given them affirmation for the

9 amount of work that it took them to do that.

10 And so if you want to work with us as

11 to how we’re going to make it something that can

12 be shared, that would be fantastic. I think

13 it’s -- you hit it spot-on.

14 CHAIR SCHNEEMAN: So Tim I’m going to

15 add you and I’m going to add myself.

16 So -- Heather.

17 MEMBER LEIDY: Heather. This is more

18 just a clarification, a methodology question. At

19 the last meeting, you brought up the analytical

20 framework, but I think it’s a little more teased

21 out now.

22 And so my question is related to


43

1 whether -- and I don’t think this is the case, but

2 I’m going to ask anyway. So there are studies were

3 just varying macronutrients, and so some of the

4 public comments in the discussions were about, you

5 know, ketogenic diets or low-carb diets.

6 And so when you look at those studies

7 from a manuscript perspective, a lot of them are

8 prescribed from varying macronutrients, not food

9 first. And so my question is that I would imagine

10 that a lot of those studies were excluded based on

11 the definition of the dietary patterns and your

12 analytical framework.

13 And so just to clarify that, because it

14 seems like a lot of the dietary patterns were -- the

15 studies were selected, and then macronutrient

16 composition was then kind of described and compared

17 in the subsequent analyses, and so a lot of the

18 studies -- maybe not for all-cause mortality, but

19 I think as we get into the other outcomes that we’d

20 have more randomized controlled trials, most of the

21 studies -- maybe not the most, but a good number

22 of them would actually be macronutrient


44

1 composition first, but because they are generally

2 not always describing the foods in those diets,

3 just to clarify, they would actually be excluded

4 from these analyses?

5 Is that correct? Because they’re not

6 foods, they’re generally macronutrient-specific

7 comparisons? And that’s not in your analytic

8 framework.

9 MEMBER BOUSHEY: Do you want to speak

10 to that?

11 MEMBER BAZZANO: We did specify that

12 even if they didn’t describe the foods, but if they

13 had a macronutrient intake that was outside of the

14 AMDR for any of the micronutrients, carbohydrate,

15 fat or protein, we included them, even if they

16 didn’t have the food description, but they had a

17 nutrition description like what the components

18 were.

19 For instance, what kinds of fats, what

20 kinds of fiber, et cetera. If they had any kind

21 of a description like that, they were included.

22 MEMBER LEIDY: Okay. So then just to


45

1 clarify in terms of the definition, or maybe I

2 missed it, it seemed like the dietary pattern

3 definition was really looking at foods.

4 MEMBER BOUSHEY: Yes.

5 MEMBER LEIDY: But that would be

6 different than --

7 MEMBER BOUSHEY: But that’s for

8 dietary patterns. The macronutrient distribution

9 is a completely different concept.

10 MEMBER LEIDY: Okay.

11 MEMBER BOUSHEY: Yeah. It’s in

12 addition to. It’s not -- the dietary -- when we

13 look at the macronutrients, we’re just looking at

14 the macronutrients.



17 MEMBER LEIDY: So it’s basically a

18 separate -- it’s a separate question from the

19 dietary patterns, then.

20 MEMBER BOUSHEY: It is.


22 MEMBER BOUSHEY: It is. I


46

1 mean, -- yeah, because they’re not the same.

2 MEMBER BAZZANO: And then the main

3 issue here is that it’s all-cause mortality.

4 MEMBER LEIDY: Right. I --

5 MEMBER BAZZANO: I mean, that’s our

6 outcome for this one. There will be randomized

7 controlled trials in other --

8 MEMBER LEIDY: I was just more looking

9 forward when -- when the next analytic framework

10 we see and the other outcomes. I thought if it was

11 the same, it’s going to miss those diet

12 comparisons, just based on the definitions of what

13 you have in your analytic framework.

14 MEMBER BOUSHEY: Right. And for the

15 macronutrients, that’s a whole -- that was that

16 different definition on that second page.

17 CHAIR SCHNEEMAN: Can I -- I know we

18 have a comment from staff, but keep in mind that

19 in the analytic framework under the inclusion and

20 exclusion criteria, if there’s a particular diet,

21 but it’s really a treatment diet -- and that’s the

22 whole point of the study -- that would not


47

1 necessarily get included as well.

2 So that’s another factor to keep in

3 mind.

4 MS. ENGLISH: This is Laural English.

5 So just to clarify, I think, the points, the

6 comments that were just mentioned are accurate, but

7 we kept the analytic framework with just that more

8 simplified version, that -- really to speak to the

9 overall package of the diet.

10 And so the intent was to cover the

11 dietary pattern, as Dr. Boushey had shown in the

12 definition, particularly if you notice in the

13 definition, there’s -- defined by the foods and

14 drinks as well as nutrients when available.

15 And so it was the case where there was

16 a paper or an included article that looked at the

17 dietary pattern but also reported enough

18 information and the macronutrient distribution in

19 which, one, fell out of the AMDR.

20 However, we also included articles that

21 were just based on the macronutrient distribution,

22 because in the criteria, because in the criteria


48

1 it does specify that the foods or food groups do

2 not need to be required for inclusion based on the

3 diet, or where the diet is based on macronutrient

4 distribution.

5 So the framework is a little more

6 simplified, but the inclusion and exclusion

7 criteria gives a little more detail to speak to

8 that.

9 CHAIR SCHNEEMAN: Tim?

10 MEMBER NAIMI: Yeah. I was just

11 wondering. I -- Tim Naimi, Boston University.

12 You may be getting to this later, but for the

13 studies of all-cause mortality, I was interested

14 in how does the distribution of cause of death break

15 down? Where is the reduction in mortality? Is

16 there any general comments you can provide on that?

17 MEMBER BOUSHEY: Yeah. I don’t think

18 we did that. That’s an interesting question. We

19 did not. It was just all-cause. We certainly

20 would probably have it from many of the studies.

21 So perhaps that would be something of interest to

22 do. It just varied across the range.


49

1 Good question.

2 MEMBER TAVERAS: Carol, I was

3 wondering if -- I know you said this is going to

4 be covered in the next meeting, but could you talk

5 a little bit about the decisions that you’re

6 weighing for reprioritizing the cancer and

7 neurocognitive health and bone health questions?

8 Is there room or time to weigh on maybe

9 some of those decisions about using existing

10 reviews or what some of those endpoint outcomes

11 are?

12 MEMBER BOUSHEY: We are going to use

13 some. You know, I don’t have the list here, but

14 here’s -- just to -- remember when we had our first

15 meeting, and we were all so excited and stuff?

16 So what happened, well, we thought we

17 would get this done in a week. Right? And so

18 when -- remember I had kind of open forum, because

19 there was a list of what cancers we were going to

20 look at.

21 And recall that we said, well, let’s

22 have some more. And so -- we added in liver


50

1 cancer, I believe, and then pancreatic cancer.

2 Isn’t that -- weren’t -- those were the two we

3 added in.

4 And so as we see how much work all this

5 is, we’re thinking of maybe recommending that the

6 next group do liver and endometrial cancer, and by

7 that time, there’s going to be really a lot of data

8 for them to use.

9 And then the other one -- in fact, I

10 should probably -- let me punt this over to you all,

11 because you know which ones are going to be coming

12 out, but they were all the ones we added when we

13 had our wonderful first meeting.

14 We were just so -- thinking we could get

15 through this in a day. So do you want to

16 add -- what were the others?

17 MS. ENGLISH: So the other cancers

18 specifically or the other --

19 MEMBER BOUSHEY: Good question. Did I

20 get them all with those two?

21 MS. ENGLISH: I think so. Yeah.

22 There was childhood leukemia, liver and


51

1 endometrial.

2 MEMBER BOUSHEY: Oh, yeah. Those were

3 all added. And then what in the -- there was

4 another set that we also eliminated, some that --we

5 also -- so I thought we eliminated some others.

6 MS. ENGLISH: I think those were the

7 new cancers added --

8 MEMBER BOUSHEY: Okay.

9 MS. ENGLISH: -- so the existing

10 reviews for the other four breast, lung, prostate

11 and colorectal cancer. So those were the four

12 other --


14 Did -- hearing that list, did you have some that

15 you think we should definitely try to address?

16 MEMBER TAVERAS: I was wondering where

17 you think you might carry forward in existing

18 reviews?

19 MEMBER BOUSHEY: Oh, the -- let me look

20 at the notes here again as to which one. So you

21 have them memorized better than me. Which ones

22 will we carry forward with existing reviews?


52

1 MS. ENGLISH: For the bone health

2 question, there’s an existing review as well as the

3 neuro, so with bone health, it’s pretty much just

4 a very similar framework, instead of outcomes that

5 was in the existing review.

6 For neuro, there are several additional

7 outcomes. The existing review covered more of the

8 realm of neuropsychological illness or depression,

9 and Alzheimer’s disease and cognitive impairment

10 type outcomes, and so those are -- those were

11 covered in the existing reviews.

12 Additional outcomes were anxiety, ADHD

13 and autism spectrum, and then more of the childhood

14 outcomes with developmental domains, and those

15 were not exclusively covered in the existing

16 review.

17 MEMBER TAVERAS: And will those then

18 not be reviewed? I’m particularly interested in

19 the neurocognitive outcomes --

20 MEMBER BOUSHEY: No.

21 MEMBER TAVERAS: -- than if --

22 MEMBER BOUSHEY: No. We’ll update


53

1 them.

2 MEMBER TAVERAS: Those are --

3 MEMBER BOUSHEY: And this is -- what

4 we’re doing is, we’re not going to go from scratch,

5 like what we’ve just done. We’ll update those.

6 MEMBER TAVERAS: From -- in the last

7 five years?

8 MEMBER BOUSHEY: Yeah. And I believe

9 someone did that yesterday. They spoke to that

10 from B-24. Oh, yeah, because they had all that

11 work from -- done earlier. That will -- yes. So

12 that isn’t going to be lost.

13 CHAIR SCHNEEMAN: Actually, I want to

14 take a turn, too. So I would be interested in the

15 comments -- and I know the subcommittee has been

16 talking about this, that just sort of -- one of the

17 dilemmas with looking at the macronutrients in

18 isolation, where it’s not considering diet quality

19 that -- you know, do you wind up with some of the

20 inconsistency that you really have to factor in

21 diet quality once you start dealing with the

22 macronutrients?


54

1 So I’d be interested in some discussion

2 about that.

3 MEMBER BOUSHEY: Yeah. It’s so much

4 fun. Do you want to -- it is --

5 MEMBER MAYER-DAVIS: I was going to

6 refer to Jamy, because we -- our committee has

7 given this a great deal of thought. It also

8 relates to Rachel, Dr. Novotny’s comment about

9 integration, really, across subcommittees.

10 So -- but Jamy really initiated some of

11 this conversation, so let me have you comment on

12 hierarchy.

13 MEMBER ARD: Okay. Jamy Ard. So I

14 think the way we really sort of looked at the scope

15 of the data for all-cause mortality really starts

16 at a few different levels, and I think it does lead

17 to a fairly consistent narrative and the conclusion

18 that you saw, that the dietary pattern is really

19 driving the overall effect, and the dietary

20 pattern -- the consistency of that effect or the

21 strength of that effect, the effect size, is likely

22 related to the food group consumption and the


55

1 adherence to the dietary pattern.

2 So you can have a DASH dietary pattern

3 that you say you’re following, but there’s levels

4 of adherence, and if you are closer to an ideal,

5 as studied in the original DASH trials dietary

6 pattern, then you see the strongest effect.

7 If you start to dilute that in terms of

8 changes in the food groups and quality of the foods

9 that are part of that pattern -- so you may still

10 be technically, you know, consuming fruits and

11 vegetables and whole grains and low-fat dairy and

12 so forth, but if the quality of that starts to

13 decrease, you see a decreased effect.

14 So there are trends, and we didn’t

15 report on that, but there are fairly consistent

16 trends even within a dietary pattern. As you go

17 from higher adherence to lower adherence, you see

18 decrease in effect sizes in terms of

19 protectiveness.

20 And then -- so you also then look at it

21 from the macronutrient standpoint, and so that’s

22 how we got to this idea of -- well, let’s look at


56

1 the macronutrients outside of the AMDR, because

2 there’s a lot of public interest in this idea of

3 if I am eating fewer carbohydrates or if I am eating

4 higher fat content, is that beneficial, is that not

5 beneficial?

6 And so this literature gave us an

7 opportunity to say, what can we see in that regard?

8 And the fairly consistent thing -- even though the

9 overall data are inconsistent, the fairly

10 consistent thing was that, within the context of

11 a given dietary pattern, you saw there’s really not

12 much effect of the independent macronutrient

13 distribution.

14 Right? It always rolls up to the

15 dietary pattern that you are considering. And so

16 once you start to think about -- okay. We’ve

17 looked at it from the overall dietary pattern, and

18 we see a fairly consistent response across all of

19 this literature.

20 We’ve got, even within that literature,

21 some different food group analyses, and so not

22 everything was about dietary patterns. Some of


57

1 those were, you know, diet patterns that were high

2 in fats or sugar-sweetened beverages or different,

3 you know, clusters of food groups that people

4 looked as a -- and named as a dietary pattern.

5 And you saw, again, fairly consistent

6 results, that higher-quality foods tended to lead

7 to more consistent protective effects. And then

8 you -- we also looked at it from a macronutrient

9 standpoint.

10 And in every instance, you had to come

11 back to the conclusion that the effects are being

12 driven by the dietary pattern, so it creates this

13 sense of a hierarchy, right, where we could say at

14 the top level, in the context of energy overall,

15 energy intake overall, we have dietary pattern, and

16 so you know, how you consume your calories and the

17 combinations of foods that you put together

18 overall, that is what matters most.

19 Then within that, it’s the quality of

20 the foods that make up the dietary pattern. And

21 then finally it’s the macronutrients that are

22 contributing from the foods that you’re consuming.


58

1 And those do have some -- I’m not saying

2 that those don’t have some biological effects.

3 They do. But from a perspective of all-cause

4 mortality, it seems to all be driven by this idea

5 of a dietary pattern, and quality is the thing that,

6 you know, sort of links all of these together.

7 Right? So high-quality intake at the

8 pattern level, high-quality food choices at the

9 food group level, and even the quality of the

10 macronutrients, high-quality fat intake, for

11 example, or quality protein, and where those

12 protein sources are coming from.

13 Those things do matter in terms of the,

14 you know, sort of, underlying consistency across

15 that hierarchy. And so I think in that way, it does

16 provide a fairly unifying theme, narrative, to say,

17 maybe at some level we’ve been too fascinated with

18 macronutrients, and that’s not gotten us anywhere,

19 really, and we should continue the narrative that

20 the other committees have started, where we’re

21 starting to make this pivot to.

22 Well, let’s actually really try to get


59

1 people to look over here and think in terms of their

2 overall pattern of consumption. And that may be

3 more beneficial; it seems to be more powerful, and

4 certainly it seems to be more consistent.

5 The evidence is very, very clear. I

6 mean, the magnitude -- as Carol said, the magnitude

7 of consistency across hundreds of studies, across

8 hundreds of countries and different populations

9 and subgroups, men and women.

10 That is fairly clear. So I think

11 that’s one way to potentially conceptualize this,

12 and Carol alluded to the idea of -- if we can come

13 up with something that helps us visually --

14 MEMBER BOUSHEY: Well, we know we

15 should really share that we have the volunteer for

16 that. Dr. Heymsfield has volunteered to make our

17 visual on that, and that is one of our big tasks.

18 But we have Dr. Sabaté. Yeah.

19 MEMBER SABATÉ: To say it in a slightly

20 different way, I mean, for a long time, we have

21 focused on macronutrients, and especially the

22 amount of macronutrients, and the amount of


60

1 macronutrients translates into the proportions as

2 far as percentage of proteins versus fats versus

3 carbohydrates.

4 And as we look at these, I mean, we

5 realized that it’s the type of macronutrients and

6 particularly the source that comes from foods, and

7 so although the macronutrients may be having the

8 same name, I mean, all come originally from foods.

9 And so it’s the type of macronutrients

10 and the source of the macronutrients that may be

11 the influence. But when we take these outside the

12 context of the food patterns and the foods then,

13 in our analysis we could find much more consistency

14 of the results.

15 But we put into the context of dietary

16 patterns and the foods, that is the type and the

17 source, then that starts making sense.

18 CHAIR SCHNEEMAN: Lydia?

19 MEMBER BAZZANO: Okay. I would also

20 just like to make the point, the same point that

21 Joan here has made. But I mean, if you think about

22 a plate that has salmon and non-starchy vegetables


61

1 on it, that is -- with olive oil, that’s

2 Mediterranean.

3 That’s also low carbohydrate

4 or -- so -- it’s not the dietary -- it’s the

5 dietary pattern overall and includes what it comes

6 from much more so than the specific differences

7 in macronutrients.

8 And I will say that we didn’t have a lot

9 of macronutrient differences. None of these were

10 low-carbohydrate diets. They were all just barely

11 below the AMDR or barely above, depending on which

12 macronutrient it was, so I don’t think you take this

13 and look at it specifically for those purposes,

14 because it wasn’t -- this information wasn’t meant

15 to be --

16 MEMBER BOUSHEY: Right.

17 MEMBER BAZZANO: -- looked at for those

18 purposes. The study wasn’t designed for those

19 sorts of things.


21 MEMBER NOVOTNY: Just to kind of

22 comment. I was thinking about the lack of evidence


62

1 in childhood for all-cause mortality, and I assume

2 it’s lack of data, and of course, you hope children

3 aren’t dying early and so on.

4 But that would be an interesting set of

5 data to have. I’m also thinking about having

6 excluded the B-24, and where there might be data,

7 and thinking of EMRs and potentially at least

8 infant feeding data, and data that might be

9 available, if nothing else, for future

10 recommendations.

11 MEMBER BOUSHEY: Yeah. And it might

12 come up in our other questions.

13 MEMBER NOVOTNY: Yeah. And then

14 totally different -- you know this a topic of mine,

15 but this starchy vegetable thing, I -- you know,

16 I think here in the U.S. we usually think about

17 potatoes, and you know, I’m sure many people can

18 find value in potatoes.

19 Certainly in the region I work there is

20 a variety of nutrient-rich, starchy vegetables.

21 So just to -- it is a problem in our analyses, so

22 I think we need to create a category for and


63

1 actually look at the role of starchy vegetables,

2 because they also are not high calorie, depending

3 on how they’re cooked.

4 So I just think that they deserve more

5 attention in our patterns.

6 MEMBER MATTES: Well, I want to

7 follow -- I think Jamy’s description of the data

8 is very, very important. You know, we, I think,

9 mostly recognize that even small changes in body

10 weight have disproportionate health benefits, and

11 the dose response kind of findings that you have

12 here raise the same question.

13 If the population even makes small

14 changes in the direction of these dietary patterns,

15 can we expect disproportionately large health

16 benefits? To the degree that you can quantify

17 sort of the magnitude of change necessary to

18 realize benefit, I think that would be a very

19 powerful message.

20 MEMBER BOUSHEY: Well, Rick, this will

21 be interesting, because as we’ve all said, you

22 know, we will hopefully get some randomized trials


64

1 in the next topics that aren’t, you know, all-cause

2 mortality.

3 And you know, I think that that’s going

4 to be one of, you know, the type of diets that we’ll

5 be looking at. We’ll be looking at dietary

6 patterns. And so that will really help with

7 answering that. That’s a good point.

8 CHAIR SCHNEEMAN: I also wanted to come

9 back on -- I think it was in the Pregnancy and

10 Lactation subcommittee report yesterday. We had

11 some discussion of food patterns, and as I recall,

12 it sort of resonates very well with what we’re

13 hearing from the Dietary Patterns group, and it

14 would be interesting to hear some comments.

15 MEMBER DONOVAN: For that, we were

16 depending on the existing systematic review, and

17 so Jamie was on that text, so maybe -- would you

18 like to address that?

19 MEMBER STANG: Sure. So when -- Jamie

20 Stang -- when we did the pregnancy collaborative

21 before this Committee met to do those

22 reviews -- and they’re published -- one of the


65

1 things that we came down to is looking at dietary

2 patterns, again, echoing that it came down to

3 specific foods, because we had like the new Nordic

4 diet, and the DASH diet and five kinds of

5 Mediterranean diets, and -- but when you looked at

6 them all, there were some very consistent

7 components.

8 In each of the diets that had a positive

9 effect, you could pull out, with a very good degree

10 of consistency across the studies, that it was

11 fruits, it was vegetables, it was nuts and seeds.

12 And so that’s why we felt very strongly

13 in our conclusion statements, that rather than

14 naming the diets or talking about the healthy diet,

15 that we put in those food components, because

16 that’s how people eat.

17 Right? They select fish and nuts and

18 seeds. They don’t select a Mediterranean diet

19 when they’re in their kitchens or in their grocery

20 store. So it seemed to be so consistent and so

21 blatant that it just felt like it needed to be

22 specified and those conclusion statements.


66

1 And I think, again, that’s the -- you

2 know, that is what we want to be able to tell people

3 is, you can call it what you want, but it is -- these

4 are the things that make up those diets that seem

5 to have the health benefits.

6 CHAIR SCHNEEMAN: Other comments or

7 discussions. Oh, Jamy, please.

8 MEMBER ARD: I think -- Jamy Ard -- so

9 I think one other thing that this points to is the

10 idea that certain things are bad or not bad or good

11 or so forth or -- I mean, that’s something we’ve

12 got to sort of grapple with.

13 Right? So I mean, as I think about,

14 like, Lydia’s comment around, you know, a plate

15 with lean protein or fish and vegetables being

16 characterized as low carbohydrate in that

17 particular meal and instance and being also

18 consistent with Mediterranean style of eating, I

19 think one of the things that’s confusing for

20 people, though, is, well, a lot of these dietary

21 patterns include -- actually include and give you

22 more points for consuming higher amounts of


67

1 vegetables that -- or I mean, fruit or whole grains

2 or those types of things.

3 So I think we’ve got to be careful in

4 terms of helping people understand the nutritional

5 value of these foods and not get confused by the

6 idea of, well, if it has any carbohydrate, it’s

7 bad.

8 Right? I think that’s where we need to

9 sort of come up with a way to help people understand

10 this idea of quality of intake, because again even

11 within any of the patterns, when the quality was

12 poor, the effect was either null or reduced, and

13 that was definitely consistent.

14 So all carbohydrates are not equal.

15 All protein is not equal. All fat is not equal.

16 All foods are not equal. All dietary patterns are

17 not equal. Right?

18 And so we’ve got to help people

19 understand the nutritional value of foods and how

20 we put those together to get the maximum impact

21 based on the evidence we have.

22 I think if we don’t say something to


68

1 that, then we’re going to miss an opportunity to

2 really help people do the things that we’re talking

3 about in terms of nutrients of public health

4 concern yesterday, where if we say, well, we want

5 people to be able to eat diets that are overall

6 healthier but we’re afraid of eating a piece of

7 fruit, then that’s a problem.

8 I think that’s a problem.

9 MEMBER BAZZANO: I just want to second

10 what Jamy said, and that it’s the lack of nuance

11 I think gets us into trouble because it is the foods

12 that are high quality that we need to be focusing

13 on.

14 CHAIR SCHNEEMAN: I would suggest we

15 take a break right now, and then we can come back

16 at 10:30 hear the next subcommittee. Is that

17 agreeable to everyone? Okay. So we’ll be back

18 here at 10:30, then.

19 (A short recess was taken.)

20 CHAIR SCHNEEMAN: Okay, if we could

21 reconvene, please? Yeah. So we have one more

22 subcommittee report to go through before the --


69

1 before we take the break at lunch. And I will just

2 note that whatever time we’re done, we will have

3 to take a break, because they do need to set up the

4 room to facilitate the public comments.

5 So want to -- yeah.

6 VICE CHAIR KLEINMAN: Our next speaker

7 is Dr. Steve Heymsfield, and he’s going to present

8 the summary findings of the committee that looked

9 at frequency of eating. Steve?

10 MEMBER HEYMSFIELD: Thank you, Ron.

11 First, let me begin by thanking my committee

12 members, Carol, Heather and Rick, who have really

13 contributed a lot to this report. And also, we

14 have finished our review.

15 We’re complete. So this is going to be

16 a rather long presentation, but that’s it. We’re

17 done. Yeah.

18 (General laughter.)

19 (Off-mic comments.)

20 MEMBER HEYMSFIELD: No, no. I know

21 that. We do have that.

22 Anyway, this is a new topic for the


70

1 Dietary Guidelines -- frequency of eating, and I

2 thought I might begin just by a very brief summary

3 of this topic, because it’s also new to me.

4 And if we think about eating behavior,

5 which is the major topic of the Dietary Guidelines,

6 there are three parts it -- to eating behavior.

7 One is the quantity of food people eat.

8 The second is the quality of the food they eat, and

9 that’s the major deliberations that we’ve heard so

10 far, and that’s been the topic of the Dietary

11 Guidelines for quite some time. But there’s a

12 third part to it, and that’s the frequency and

13 timing of eating -- frequency and timing of eating

14 -- and that, together with the other two, quality

15 and quantity, determine eating behavior.

16 And the frequency of eating is a very

17 under-studied part of this area. But there’s

18 major physiology, increasingly understood

19 physiology that relates to the frequency of eating,

20 the number of times you have an ingestive event per

21 day, even including water.

22 So, it’s a very important and


71

1 interesting topic, and this is a new question for

2 the Dietary Guidelines. And because of that,

3 we’ve had very intensive discussions about what we

4 mean by frequency of eating.

5 So just a little brief background.

6 Normally "we eat three meals a day." That’s kind

7 of a fantasy, but we eat three meals a day, and we

8 can divide those into breakfast, lunch and dinner.

9 And that actually sums up very clearly

10 number three, is the frequency of eating, but also

11 breakfast, lunch and dinner is the timing of

12 eating, so the frequency and timing are related to

13 each other.

14 And as you’ll see, as we move forward

15 with our deliberations, we uncouple timing from

16 frequency, and I’ll explain that a little more

17 later. And the other thing we’ve struggled with

18 is, what is frequency of eating? How do you define

19 it?

20 And it boils down to what’s called an

21 ingestive event, or an eating occasion, and we

22 spent a lot of time thinking about what we mean by


72

1 eating occasions, and that comes up to the search

2 strategies we did as well, what we include as an

3 eating occasion.

4 And the tools for measuring eating

5 occasion -- they’re really two main tools, there

6 might be others, but the three-day diet diary is

7 one, and the other is a food frequency.

8 And as we plowed into those, we

9 discovered there were issues related to how you

10 measure frequency of eating. And lastly, there

11 are two types of studies, observational and

12 interventional, and each one of those we’ve been

13 able to separate out and have different criteria

14 for.

15 Well, the search strategy then on

16 frequency of eating, 41,000 articles have been

17 screened, and there were six initial questions for

18 this committee, and we’ve answered one of them in

19 the previous meeting, in meeting three, of the

20 relationship between frequency of eating and

21 mortality. And we’ll look at the remaining five

22 today. And I’ll briefly review again the


73

1 mortality question.

2 The original question was: What is the

3 relationship between frequency of eating, such

4 just meals per day, snacking, fasting and so on,

5 and each stage of life, various life outcomes?

6 And as I mentioned, the timing of eating

7 occasions is important topic, increasingly

8 important. We really focused our work,

9 particularly as we moved on -- on the number of

10 eating occasions, we uncouple those two, because

11 it turned out to be very difficult to find studies

12 that had both the number of eating occasions and

13 the timing of those occasions.

14 The analytical framework and

15 inclusion/exclusion criteria were updated at

16 meeting three after our discussions here, again,

17 focusing on the number of eating occasions and not

18 the timing of eating occasions.

19 And also, at meeting three, we

20 clarified the minimum size of study groups and

21 power analyses criteria required for intervention

22 studies. And we also noted that the requirement


74

1 for data collection on two separate occasions was

2 removed for observational studies but remained for

3 intervention studies.

4 And this issue comes up a lot about

5 observational studies. You quantify the

6 frequency of eating at the beginning of an

7 observational study, and 20 years later, you’re

8 looking at their outcome, but you don’t have a

9 second time point.

10 So, many of the observational studies

11 have only a single time point for quantifying

12 frequency of eating. And we also noted that three

13 24-hour periods was retained as an attempt to

14 capture customary frequency of eating.

15 In other words, weekdays, weekends.

16 If you have just a single 24-hour period, you don’t

17 really get a good sampling of what people are doing.

18 Now, the key definition, then, for

19 frequency of eating is defined as an ingestive

20 event, as I mentioned, an eating occasion, and that

21 include preload meals or snacks, and also

22 beverages, energy or non-energy yielding beverages


75

1 or food. That’s our key definition.

2 And for our inclusion and exclusion

3 criteria, of course, the number of daily eating

4 occasions and the inclusion criteria are studies

5 that only examine frequency of intake of a single

6 food, beverage, or category of food or beverage.

7 And as I mentioned, there are two types

8 of studies. We looked at observational and

9 intervention studies, and observational studies,

10 we used data collection for eating frequency that

11 encompasses a minimum of three 24-hour periods, and

12 that could be with three 24-hour dietary recalls

13 reporting an ingestive event, or one eating

14 frequency questionnaire documenting eating

15 frequency for the past month.

16 Those are our criteria. And the

17 intervention studies were a little different, of

18 course, those are typically going to have two time

19 points, the beginning and the end of the study.

20 And for these studies, then, we would have each

21 eating occasion that encompasses a minimum of three

22 24-hour periods, or questionnaire that covers at


76

1 least three days addressing eating frequency; for

2 example, again, the 24-hour recalls or the eating

3 frequency.

4 And we also -- for intervention

5 studies, we wanted to make sure they were powered

6 adequately. So, we decided that 15 participants

7 were required for studies using within-subject

8 analyses, or 30 participants for studies using

9 between-subject analyses, or a power calculation

10 was needed.

11 And the numbers of 15 and 30, did some

12 back-of-the envelope calculations to try and

13 figure out the minimum number of people needed for

14 a reasonable study that would give statistical

15 significance.

16 The first question we were asked of the

17 six was the relationship between frequency of

18 eating and all-cause mortality. This was

19 presented at meeting three. This was the

20 analytical framework.

21 The endpoint, then, is all-cause

22 mortality, as it relates to frequency of eating.


77

1 This one was easy. There were no studies that we

2 could find, so no evidence is available to

3 determine the relationship between the frequency

4 of eating and all-cause mortality, and therefore,

5 there’s no grade assignable.

6 Now, the remaining five questions,

7 then, is what we’ll review today. Gestational

8 weight gain, pregnancy, postpartum weight loss,

9 growth, size, body composition, risk of overweight

10 and obesity, cardiovascular disease, and type 2

11 diabetes.

12 We screened -- I’m going to have a hard

13 time reading -- over 51,000 papers, and at the end

14 of the day, that came down to 10 after rigorous

15 screening of those. And on the bottom, you’ll see

16 they’re divided up into the topics.

17 The most studies were growth, size,

18 body composition. There were six papers for that.

19 Cardiovascular disease and diabetes have two.

20 Postpartum weight loss had one, and there were none

21 for gestational weight gain.

22 So, the first topic, then, is


78

1 relationship between frequency of eating during

2 pregnancy and gestational weight gain. The

3 endpoint here is weight gain across the period of

4 pregnancy, and this is the analytical framework.

5 Eating frequency was the intervention

6 or exposure, and there were no studies that we came

7 up with between January 2000 and September 2019.

8 So like mortality, there’s no evidence available

9 to draw a conclusion about the relationship between

10 frequency of eating during pregnancy and

11 gestational weight gain.

12 The next question is what is the


14 lactation and postpartum weight loss? The

15 endpoint here is change in weight from baseline to

16 a later time point during the postpartum period.

17 And here we did find one study. It took

18 place in Sweden. Four-day weighed food records

19 were used at baseline and follow-up to measure

20 eating occasions per day. Change in

21 frequency -- of eating frequency between baseline

22 and follow-up was assessed.


79

1 The study outcome was reported as a

2 change in postpartum weight loss. And all of the

3 women in the study were overweight or obese.

4 Ninety-five percent were exclusively

5 breastfeeding. Five percent were partially

6 breastfeeding, and parity was one.

7 In this one prospective cohort study,

8 they did not find a significant association between

9 eating frequency and a change in postpartum weight

10 loss after a 12-week follow-up period.

11 So, we conclude then that there’s

12 insufficient evidence available to determine the

13 relationship between the frequency of eating

14 during lactation and postpartum weight loss.

15 The next question is, what is the

16 relationship between the frequency of eating and

17 growth, size, body composition and risk of

18 overweight and obesity. And the most papers we had

19 available that met our criteria were in this

20 category.

21 There were six papers available, and it

22 covered a broad spectrum of endpoints; for example,


80

1 body mass index, weight, weight for age, and other

2 endpoints like healthy weight, overweight, obesity

3 and so on.

4 So, there’s quite a few endpoints

5 available for this study. There were six that I

6 mentioned. One was a randomized control trial.

7 Five were prospective cohort studies. Five took

8 place in the U.S.; there was one study that was

9 reported from Greece.

10 And the number of eating occasions in

11 the comparison groups differed across the studies.

12 For example, some studies looked at two versus

13 three meals. Others looked at one versus 10, and

14 so on. So, the number of eating occasions differed

15 across the studies.

16 Three of the studies used a three-day

17 food record, and three studies used a food

18 frequency questionnaire with an added question to

19 assess the number of daily eating occasions,

20 because, as I understand it, the FFQ normally does

21 not have a question about eating occasions.

22 And the studies that we included that


81

1 had food frequency questionnaire as the tool also

2 had an added question about daily eating occasions.

3 And many study outcomes were reported:

4 BMI, change in BMI, body fat, change in waist

5 circumference and so on.

6 There were five studies in adults.

7 Three of them reported a positive association

8 between frequency of eating and growth, size and

9 body composition. Two studies did not find a

10 significant association between frequency of

11 eating and growth, size and body composition.

12 And if you’re like me, you’re probably

13 thinking, what does a positive association mean?

14 Well, okay. So positive association means that

15 more meals translate to bigger body size and

16 composition. Okay. So that’s what that means.

17 A negative association would be more

18 meals is less size and body composition, and so on.

19 And we use the words interchangeably, inverse,

20 negative and so on here. We try to be consistent.

21 So, in one study in children reported an

22 inverse association between frequency of eating and


82

1 growth, size and body composition after a 10-year

2 follow-up study. So, these are mixed kind of

3 reviews on this topic.

4 And so, these studies were inconsistent

5 in how they defined and examined frequency of

6 eating, the outcomes they examined in the reports,

7 and the reported results. They have several

8 additional critical limitations.

9 Which you’ll see again in some of the

10 other questions, there was a high risk of bias, and

11 also a high or unknown attrition rate in these

12 studies, trying to track how many subjects were

13 entered in the beginning of the study, how many were

14 at the end, and the reasons that they were taken out

15 over time.

16 So, the conclusion statement here for

17 the largest of our samples, six in this question,

18 was that there’s insufficient evidence available to

19 determine the relationship between the frequency of

20 eating and the growth, size and body composition,

21 and the risk of overweight and obesity.

22 The next question is: What is the


83


2 cardiovascular disease? And in this analytical

3 framework, the endpoint is cardiovascular disease

4 of all types, stroke, venous thrombosis, and so on.

5 We also included intermediate outcomes

6 here, lipid levels, blood pressure and so on.

7 Those are intermediate outcomes.

8 And we found two studies in adults that

9 met the inclusion criteria. Both studies were

10 prospective cohort studies. One took place in the

11 U.S. and one in Greece.

12 The number of eating occasions, again,

13 differed across the comparison groups. One study

14 used a three-day food record and one study used a

15 food frequency questionnaire, with again the added

16 question to assess number of daily eating occasions

17 at baseline.

18 And the study outcomes that were

19 reported were coronary heart disease,

20 hypertension, systolic blood pressure, and

21 diastolic blood pressure.

22 Now, one study reported an inverse


84

1 association in adults between eating frequency in

2 baseline and systolic and diastolic blood pressure

3 and risk of hypertension after five years’

4 follow-up. This is an intermediate outcome, of

5 course.

6 And one study reported no association in

7 adults between eating frequency at baseline and

8 coronary heart disease after a six-year follow-up,

9 and obviously, the net result of that was kind of

10 an ambiguous outcome.

11 The studies were inconsistent in how

12 they defined and examined frequency of eating. The

13 outcomes they examined, and in the reports -- the

14 results they reported. And again, the same types

15 of limitations. There’s a high risk of bias. The

16 attrition rates were unknown in these studies.

17 So, we concluded then that there’s

18 insufficient evidence available to determine the


20 cardiovascular disease.

21 The next question is: What is the



85

1 type 2 diabetes? Very important question. And

2 the outcome -- endpoint outcome here was type 2

3 diabetes, and we had two studies here to review that

4 met the inclusion criteria.

5 Both were prospective cohort studies.

6 Both took place in the U.S. Both used a food

7 frequency questionnaire with an added question to

8 assess the number of daily eating occasions. And

9 the outcome was risk of developing type 2 diabetes.

10 One study reported, in men -- in this

11 study, they found that men who reported one to two

12 eating occasions per day had a higher risk of

13 developing type 2 diabetes compared to men who

14 reported three eating occasions a day, not a very

15 big gradient in the number of eating occasions per

16 day, but they did find that. But when they did a

17 trend analysis, they didn’t find any trend overall

18 between the number of eating occasions. They

19 picked out that one significant finding of one to

20 two versus three eating occasions per day.

21 And the second study was actually in

22 women, and they did not find an association between


86

1 eating frequency and risk of developing type 2

2 diabetes.

3 Again, you see the same limitations

4 here. The studies were inconsistent in how they

5 defined and examined frequency of eating in their

6 results. They also again had a high risk of bias.

7 Weak study designs were present to answer this

8 question, and the attrition rates were unknown.

9 Therefore, we concluded that there is

10 insufficient evidence available to determine


12 lactation -- lactation? -- and type 2 diabetes.

13 Hmm. Okay.

14 I did not do that one. I proofread

15 these too. Okay. Well, you get the picture.

16 So, you can see that there are a number

17 of limitations across these studies. One is the

18 inconsistent and insufficient findings to draw

19 conclusions about the relationship between

20 frequency of eating and health outcomes.

21 And that by no means doesn’t mean this

22 isn’t an important question. It means that the


87

1 studies that have been done to date really are

2 inadequate to meet what we consider a very high bar

3 for examining frequency of eating, ingestive

4 events, eating occasions, and so on.

5 And for example, things like water

6 ingestion, water consumption, are very rarely

7 mentioned in these studies, something that should

8 be done in the future.

9 There are very inconsistent measures of

10 frequency of eating. For example, some studies

11 included snacks, others didn’t. Some defined

12 inter-meal internals differently and so on. So

13 very inconsistent. Eating frequency was only

14 assessed at baseline in prospective cohort studies.

15 The comparisons -- again, the number of

16 eating events were inconsistent across studies.

17 Both energy-yielding and non-energy-yielding

18 beverages were inconsistently accounted for, as I

19 mentioned, and the attrition rates were very

20 commonly unknown or undefined in the studies.

21 And the study populations did not

22 represent the race, ethnic, or socioeconomic


88

1 diversity of the U.S. population. And research

2 recommendations, there will be many coming out of

3 it, and we’ve thought a lot about what things we can

4 do to contribute to future research, but of course,

5 there’s a need for more controlled trials.

6 There’s a need to develop a consistent

7 definition of an ingestive event that includes

8 eating and drinking, and methods to quantify them.

9 We need to encourage documentation of frequency of

10 water consumption.

11 There needs to be a number of ingestive

12 events across 24 hours, at least three days of

13 ingestive event data on at least two discrete eating

14 occasions to allow assessment of estimate

15 reliability; that’s very rarely done.

16 Report information on food insecurity

17 to allow isolation of voluntary versus involuntary

18 ingestive events, important consideration. And

19 finally, the need to report key confounders and

20 other factors need important consideration.

21 So, the next step then will be

22 systematic reviews will be peer-reviewed. We’ll


89

1 collaborate with the Data Analysis and Food Pattern

2 Modeling working group for the data analysis

3 question answering what is the relationship between

4 the frequency of eating and achieving nutrient and

5 food group recommendations?

6 My understanding from Regan’s

7 presentation yesterday is that we’re going to get

8 even deeper into that. Right? There’s more

9 information about frequency of eating that will

10 generate -- might be among the most interesting

11 parts of our report.

12 We’ll use the frequency -- use the

13 findings of the completed systematic reviews and

14 data analyses to draft the scientific report of the

15 Dietary Guidelines Committee. And finally, I want

16 to thank everybody on my committee once again, and

17 the NESR staff.

18 Thanks very much.

19 (Applause.)

20 VICE CHAIR KLEINMAN: Thanks, Steve.

21 Questions? We’ll start with Regan.

22 MEMBER BAILEY: In a rare turn of


90

1 events, I have a question for Rick.

2 What -- is there research looking at the

3 reliability and validity of self-reported number of

4 eating occasions and what you would call an

5 ingestive event?

6 MEMBER MATTES: Yeah. That’s -- we

7 had substantial discussions about that. No.

8 That’s one of the issues. Frequency of eating just

9 has not been in the foremost of people’s thinking

10 about eating patterns and so on, and so there’s a

11 paucity of data, as you’ve seen, and very little

12 effort has gone into how to measure it. So no, we

13 don’t have good evidence on that.

14 MEMBER BAILEY: But I think that might

15 be changing for the next committee’s work with

16 intermittent fasting and things like that that more

17 research is going on in that area.

18 MEMBER MATTES: Right. And that was

19 frustrating for us. Heather pointed this out to us

20 many, many times. There’s a fair literature on

21 intermittent fasting and breakfast-skipping and so

22 on, and you would think that we should have


91

1 incorporated that into our analysis.

2 The problem is those studies don’t

3 report the total number of eating events in a day,

4 which we decided was the unit of time that we would

5 focus on. So, you don’t know what compensation

6 there may be.

7 Yeah, they skip breakfast, but maybe

8 they had three more snacks in the evening to offset

9 that. Without the totality of the evidence in a

10 relevant period of time, you just can’t draw

11 conclusions.

12 MEMBER NOVOTNY: I wondered whether in

13 the -- I know this wasn’t directly your question

14 but, whether in the body of evidence you looked at

15 whether there was a relationship between the

16 frequency of eating and energy intake.

17 MEMBER HEYMSFIELD: We didn’t, did we,

18 Rick? I’m trying to think. We didn’t, but that

19 should be something available.

20 MEMBER LEIDY: Yeah and -- this is

21 Heather. It was more just because it was out of the

22 scope of our question. Intake would be an


92

1 intermediate -- or a mediator of sorts. And so

2 just another comment to Rick’s point too.

3 A lot of the studies with skipping

4 meals, whether it’s breakfast, or even snacking

5 throughout the day or intermittent fasting, they do

6 publish energy intake in macronutrient content and

7 food choice and food selection, more energy

8 content, but they just don’t do the eating

9 occasions.

10 And so our -- we were trying to be true

11 the questions that we were being asked, and so it

12 was looking at eating frequency, we looked at our

13 end outcomes and they didn’t include energy intake.

14 We did use that as a covariant in the

15 model, but not -- we didn’t specifically use that

16 as an endpoint, because that was not one of

17 the -- that wasn’t part of our questions. But it’s

18 a really, really good point, and we do have intake

19 data on that.

20 It was just the fact that the majority

21 of studies that we thought would be included were

22 just not, because they didn’t report eating


93

1 frequency. It was -- they generally had a concept,

2 a topic around the eating frequency, but their -- it

3 was just looking at energy or macronutrient

4 composition.

5 MEMBER MATTES: Can I just follow up on

6 that? So not based on the papers that we reviewed,

7 but just sort of a familiarity with the literature

8 in this area, it’s one of the more interesting and

9 frustrating issues, because there is a sense that

10 increased eating frequency is associated with

11 increased energy intake, NHANES data shows that,

12 and so on, but the translation of that to body weight

13 is not consistent at all.

14 And so, resolving that inconsistency is

15 a very important question, and we just don’t have

16 the data to do it.

17 VICE CHAIR KLEINMAN: One study in

18 childhood actually showed an inverse relationship,

19 which was a little hard to figure out.

20 MEMBER LEIDY: Just another point, too,

21 you know, and Steve had said this. We

22 linked -- initially we linked to timing and


94

1 frequency, because they are obviously related, but

2 then to answer our question, we removed the timing

3 and focused on frequency.

4 There probably is more research -- we

5 didn’t review it -- on timing, but in order to

6 assess timing, you really need to also look at

7 24-hour frequency. So, they go hand in hand. So,

8 I think it’s -- our research recommendations will

9 be highlighting that point, that timing, I think,

10 is important and gets to some of these other

11 questions, but our charge was really looking at

12 eating frequency.

13 MEMBER DEWEY: Yeah. Thanks very

14 much. I have three questions. So, one of

15 them -- I know that you had these criteria for the

16 number of times that dietary intake frequency was

17 assessed, and there was -- that was also for the

18 randomized controlled trials.

19 So, my question is, were there any

20 randomized controlled trials excluded because they

21 didn’t have enough dietary assessment days

22 according to your criteria?


95

1 I brought this up at the last meeting,

2 so I’m a bit concerned, because a randomized trial,

3 when you’re assessing that aspect, it’s really a

4 measure of adherence. And so, it’s a little

5 different than for the observational study, so I’d

6 just like to know if any were excluded for that

7 reason?

8 And then there was one randomized trial

9 for the growth, size and body composition outcomes,

10 that I’d like to know a little bit more about that

11 one, the size, the target group and what they found,

12 just because that’s a stronger design than others.

13 And lastly, there was a slide for the

14 diabetes outcome, where I think you said there was

15 no dose response, but the bullet said that there

16 was, so I was a bit confused. Maybe it was a typo.

17 MEMBER HEYMSFIELD: Starting with the

18 last one is probably the easiest one, I think what

19 they did is, they had -- they used an analysis of

20 variants, and found, you know, no trend across the

21 studies, but when they went in and compared

22 individual comparisons, like two versus three meals


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1 a day, they got statistical significance.

2 Isn’t that it, more or less, Rick?

3 That’s what they did.

4 MEMBER DEWEY: Well, the second bullet in

5 the slide says, in the same study, there was also

6 a significant dose response with --

7 MEMBER HEYMSFIELD: Yeah.

8 MEMBER DEWEY: -- increased eating

9 occasions and risk of type 2 diabetes.

10 MEMBER MATTES: Oh, that might be an

11 error.

12 MEMBER HEYMSFIELD: I think that was

13 not -- again, I don’t think that’s right, from what

14 I recall.

15 MEMBER MATTES: Yeah. I think there

16 was a significant P for trend --


18 MEMBER MATTES: -- but there -- a

19 non-significant P for trend, but in a separate -- it

20 wasn’t like in and over and then they went back and

21 did a post-hoc to see where a difference may have

22 occurred.


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1 In a separate analysis, they just

2 happened to notice that -- the distinction between

3 eating once or twice versus three times --

4 MEMBER HEYMSFIELD: Right. Yeah.

5 MEMBER MATTES: -- was significant, and

6 you know, I don’t want to accuse them of P-hacking

7 or whatever, but --


9 MEMBER MATTES: -- there are many, many

10 pair-wise comparisons one could do in that data set,

11 and it just happened to be one, and it isn’t

12 necessarily the most logical one that one would have

13 a priori examined.

14 MEMBER LEIDY: And, Steve, I can answer

15 the question. One of the ones as far as randomized

16 control trials, and whether they were excluded

17 based on two separate occasions.

18 And I can defer back to the NESR folks,

19 but I’m pretty sure that that wasn’t the case, that

20 when they were -- the studies that were excluded

21 were primarily the -- I don’t want to say primary.

22 Some of them were because of the lack of


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1 three-day assessments and not the pre-/post-but as

2 you know, when these papers get reviewed, it’s when

3 there’s one limitation that kind of -- that

4 explanation kind of stops there.

5 But if I remember -- I don’t know where

6 our folks are that can comment on that. I

7 think -- if I remember in our discussion that there

8 weren’t any that were excluded just based on dietary

9 intake, like the three-day collections. Is that

10 true?

11 DR. OBBAGY: That is -- there were some

12 that were excluded because they did not capture

13 three 24-hour periods in their assessment. I think

14 there were some that were also excluded because they

15 didn’t assess baseline eating frequency when they

16 enrolled subjects in the study.

17 They often had the follow-up assessment

18 of adherents, but they didn’t capture their

19 baseline eating frequency at the point of

20 enrollment in the trial, or they didn’t report

21 baseline eating frequency.

22 MEMBER DEWEY: But again, I’m not


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1 focused on the observational studies right now. I

2 just want to know, of the randomized controlled

3 trials, were any excluded because of these issues?

4 DR. OBBAGY: Yes. That was in

5 reference to the randomized control trials.

6 MEMBER DEWEY: Okay. So, for me at

7 least, it would be helpful to have a little more

8 information on those, because they are a much

9 stronger study design, and I’d just like to see, you

10 know, what they were about.

11 And then, the other question was that

12 one randomized controlled trial that you did

13 mention. Can you tell us any more about that one?

14 MEMBER HEYMSFIELD: I have some

15 information about that one. It was a very small

16 study. I think they called it a pilot study.

17 DR. OBBAGY: Yeah. Correct. There

18 were 45 subjects analyzed in two groups where they

19 compared a three-meal group -- so three meals per

20 day -- versus a grazing group, which was instructed

21 to graze by eating 100 calories every two to three

22 hours.


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1 That was sort of the general gist, men

2 and women, but small sample size overall, and the

3 results that Steve described on the slide. This

4 one may be worth noting, that they did not adjust

5 or control energy intake in this trial.

6 So, the three-meal group did have

7 statistically significant lower energy intake than

8 the grazing group. So that supports Rick’s point

9 earlier about energy intake with increasing -- with

10 increased eating frequency.

11 MEMBER DEWEY: But that’s sort of the

12 point, isn’t it, that that’s an intermediate

13 variable that -- I wouldn’t call it a confounder,

14 and I think it’s an important observation if that

15 was the case.

16 DR. OBBAGY: Correct.

17 MEMBER DEWEY: Thanks.

18 MEMBER TAVERAS: And I think similarly,

19 is it right that there was just one study in

20 children? Is there more information about that

21 one? Because the inverse association is somewhat

22 paradoxical.


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1 Is there any more information about

2 sample size, what age the children were, where the

3 exposure was assessed?

4 MEMBER BAILEY: This is kind of similar

5 to that. It might be related to physical activity,

6 so the more frequently you exercise, you eat more

7 frequently, you -- I mean, is that captured in any

8 of this literature?

9 MEMBER MATTES: No.

10 DR. OBBAGY: Elsie, to answer your

11 question, the data from that analysis were from the

12 NHLBI Growth and Health Study -- so it was nine- to

13 10-year-old females only, so it was a pretty limited

14 population in terms of just girls and just at nine

15 to 10 years of age.

16 And there were about 2,000 subjects in

17 the analysis. And they adjusted for physical

18 activity.

19 MEMBER MATTES: And if I can just follow

20 up on your point, the questions about the

21 association between eating frequency and body

22 weight change or energy intake truly are two-tail


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1 tests.

2 You can make very reasoned hypotheses in

3 either direction, so neither one should sort of

4 stand out as unexpected, but we don’t have the data

5 to say which is more valid.

6 MEMBER LEIDY: Just another

7 clarification point. If I remember correctly,

8 that the intake data was also different at baseline

9 before they even started the intervention with the

10 three versus grazing. Is that correct? So it

11 wasn’t that, over time when the pre-

12 post-assessments were different at intake, at least

13 in some of these studies, they actually didn’t

14 adjust for intake at baseline, and they were, in

15 fact, different at baseline.

16 If not this study, I know that there were

17 a few others that we reviewed where that was the

18 case. So that wasn’t adjusting for the differences

19 at baseline to begin with, which was a confounding

20 factor.

21 MEMBER TAVERAS: Heather, does that

22 mean that the exposure was measured at one time and


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1 not longitudinally or change in the --

2 MEMBER LEIDY: Well, it depends on

3 which study. In the kids’ study, they did measure

4 it at baseline and then post-study. I just can’t

5 remember. There were a few studies that I’m

6 getting mixed up on with baseline, though -- that

7 their intake data at baseline was different, but

8 that wasn’t adjusted for as a covariant in the

9 model.

10 And so, it raises a question, because

11 they were starting -- they had different intakes at

12 baseline before they had the intervention.

13 MEMBER TAVERAS: So how consistent the

14 pattern was --

15 MEMBER LEIDY: Right. Followed.

16 VICE CHAIR KLEINMAN: And it also

17 raises the question about how reliably you’re

18 capturing their eating frequency when you have a

19 10-year study and you measure it twice. So I think

20 it’s challenging outcome with a lot of challenging

21 methodologic aspects to this study itself. Is that

22 fair?


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1 MEMBER MATTES: Yeah. I think it’s

2 fair to say, and the evidence on trends in eating

3 frequency are very strong and clear. We’ve

4 increased, in adults, probably one and a half

5 ingestive events a day as a population, which is

6 remarkable, and one eating event a day in kids. So,

7 if you don’t track that over time, you’ve missed a

8 great deal of information.

9 MEMBER NOVOTNY: Just as a

10 clarification -- I may have missed it -- so

11 the -- was water considered an ingestive behavior

12 then?

13 MEMBER HEYMSFIELD: Yes.

14 MEMBER NOVOTNY: So we -- so that may

15 also be something that’s changed in how we’ve

16 measured this across time?

17 MEMBER MATTES: Yeah. It is an

18 ingestive event, in our opinion, but it was not a

19 criteria by which we excluded a study, because we

20 recognized people just have not been recording

21 that.

22 There would have been no studies to


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1 review if we had used that as a criteria. We think

2 it’s important going forward, but we didn’t impose

3 that as a standard here.

4 VICE CHAIR KLEINMAN: Any more

5 comments?

6 MEMBER HEYMSFIELD: I think we’re

7 getting more data from cell phones. People take

8 pictures and they can record time and what they ate

9 and so on, and so there have been several very

10 prominent papers on eating frequency in

11 relationship to cell phone use and so on in small

12 populations, but there will be more data on this

13 subject.

14 MEMBER BOUSHEY: Yeah, I think that

15 really is an excellent point, because what’s

16 going -- with mobile-based methods, we will be able

17 to get more information on this very topic, and it’s

18 going to be one of the best uses of being able to

19 have these images, and it was because of this

20 Committee going back and looking at all of our

21 images that we have.

22 And I can’t reveal anything, because


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1 it’s all not finished up, but it’s been pretty

2 interesting.

3 VICE CHAIR KLEINMAN: All right.

4 Jamy?

5 MEMBER ARD: So -- Jamy. One other

6 question on the results related to the five studies

7 in adults where three studies were positive or had

8 a positive association. I think you mentioned that

9 there were challenges because they used a variety

10 of different measures or outcomes related to

11 growth, size and body composition.

12 Were any of those, you know -- did any

13 of them have any similar outcomes across those three

14 studies? Or are we talking about, you know,

15 differences in, you know, sub-cu fat versus, you

16 know, weights or BMI or --

17 MEMBER HEYMSFIELD: I want to say they

18 were mainly BMI, as I recall; I think they were

19 primarily BMI.

20 VICE CHAIR KLEINMAN: All right. So

21 what’s next?

22 CHAIR SCHNEEMAN: So what’s next is


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1 more general Committee discussion again, and we do

2 have time before the lunch break. So you know,

3 again, we heard quite a few of our subcommittees

4 yesterday, the additional two today.

5 So I’d just like to take whatever time

6 we have to go round, and I’m going to strategically

7 start with Jamie. So again, any observation

8 relative to the subcommittees you’ve been hearing

9 from, but also as you think about it in the larger

10 context, it’s just helpful for our overall

11 discussion.

12 MEMBER STANG: Yeah. I haven’t had

13 much time to think about this, but I think what keeps

14 coming to my mind is, how consistently each of the

15 committees are saying that there’s some very

16 specific limitations, particularly around

17 assessment of diet, and I think that, as we think

18 about this individually as committees, then

19 thinking about what that is that is cutting across

20 all of these committees, then those should be our

21 real big priority recommendations for moving

22 forward.


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1 CHAIR SCHNEEMAN: Elsie?

2 MEMBER TAVERAS: Nothing to add.

3 MEMBER MATTES: I think some of the most

4 telling analyses are coming from the Food Modeling

5 and the Food Pattern groups, and the message seems

6 to be that there is something about the totality of

7 the diet that is meaningful and a target for making

8 recommendations that could indeed have some impact.

9 And that being true, I just want to kind

10 of repeat myself from yesterday, that we don’t eat

11 nutrients. We eat foods, but we choose foods based

12 primarily on palatability. In the U.S., we have

13 the luxury of spending less than 10 percent of our

14 discretionary income on food.

15 As a result, we can just pick foods we

16 like. We’re not forced to eat foods that aren’t

17 necessarily palatable but it’s the way to get

18 sustenance. And so I think it’s very important,

19 going forward, for us to put food choice into the

20 recommendations we’re making and the determinants

21 of that.

22 Some of it is public health and access


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1 to food and so on, but a fair amount of it is also

2 the issue of palatability, familiarity, and so on,

3 and we should be mindful of that.

4 CHAIR SCHNEEMAN: Somebody else?

5 MEMBER SABATÉ: Regarding the last

6 presentation, it’s interesting to see the results

7 regarding the frequency of eating, but

8 unfortunately, since that was not your primary

9 question, and I think that it’s more of interest to

10 the general public, that is, the timing of eating,

11 and intermittent fasting was not considered.

12 So I’m afraid that maybe the general

13 public will get no guidance from this Committee, and

14 this point I think this is an important issue,

15 because it’s becoming very widespread, not only in

16 the popular media, but in many segments of the

17 population.

18 That’s one aspect that we really,

19 certainly have to include the next Dietary

20 Guidelines on that.

21 The other issue is clear, based on

22 presentations yesterday, that the average American


110

1 diet is -- needs much for improvement.

2 That it is across age segments, that

3 it’s not any particular age. It’s for both

4 genders, and I would say that it’s pretty much also

5 across ethnic or social groups. So the task that

6 this Committee has to do is to put things quite

7 clear, I mean, for the general public.

8 We all know that the information is not

9 enough to change, but at least presenting it in a

10 very clear way. And in judging a reflection after

11 the presentation of the Dietary Patterns towards

12 the conclusions, I notice -- and that is not the

13 intention probably, but that was the situation -- is

14 that the foods that we conclude that build a good

15 dietary pattern or healthy dietary patterns such as

16 fruits, vegetables, legumes, very little consumed

17 by the American public, nuts, so on and forth, are

18 mentioned only once; I’m saying on the slide.

19 However, meat that we say has to be

20 drastically reduced, is mentioned eight times. I

21 know that in the context of high versus low, and lean

22 and all this, but I mean, just from the


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1 psychological impact, anyone reading these

2 recommendations, if a word is repeated eight times,

3 and other words is only repeated once.

4 I mean, the psychological message is

5 that one food is more important than the other one.

6 So we have to aware of the way that we deliver the

7 message, even though everything written, I

8 subscribe and I agree and I think it’s appropriate.

9 I mean, just the psychological

10 impact -- I mean, how we deliver the message, I mean,

11 may have tremendous effects. So we have to be

12 careful in the way that we phrase our

13 recommendations.

14 MEMBER LEIDY: Just a comment, for

15 clarification from the Eating Frequency

16 subcommittee. We did in fact include

17 studies -- well, we set out to include studies that

18 had meal skipping or intermittent fasting.

19 They didn’t meet our criteria. So it

20 wasn’t that they were excluded because they were

21 intermittent fasting or meal frequency, but if they

22 didn’t include 24-hour eating -- documentation of


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1 eating frequency over a 24-hour period, they were

2 excluded.

3 Just a point of consideration. It was

4 part of our -- what we set out to do, but there were

5 no studies that adequately documented eating

6 frequency across the day. It’s just a point with

7 that.

8 And then, you know, just some other

9 things that came to mind. Kind of going onto what

10 Rick had said, you know, we think of it in terms of

11 dietary patterns, and then it’s really about

12 recommending the foods, but then I think, for us,

13 it’s then -- you know, people are eating foods, but

14 then there’s very specific times that they’re

15 eating them, and so it’s, you know, how much should

16 they eat them at one eating occasion and what time?

17 So I think that’s why -- just going back

18 to eating frequency, I think that it is an extremely

19 important topic, along with timing. The data right

20 now just isn’t -- we’re not able to put that in.

21 And I think in some regard it comes full

22 circle. Right? You know, back in the day, you


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1 know, there were examples of what a day should look

2 like in terms of meals and snacks and what the foods

3 are within that.

4 I think we’ve gotten away from that and

5 we’ve focused about dietary patterns, which are

6 important, but then I think, from the general public

7 standpoint, it’s really -- well, here are the foods

8 that are the most helpful.

9 We’re recommending them. But then that

10 next piece is, well, how you get them into the timing

11 and the frequency? How do you make that more

12 optimal? And we’re -- I think from what we’ve

13 gathered so far, we’re not at that point yet, but

14 I think that’s really a good future recommendation.

15 And then another part, that our Eating

16 Frequency subcommittee always joked about,

17 is -- there’s a lot of data that we’re -- that we

18 think is out there from an eating frequency

19 standpoint, but the articles that are published

20 didn’t report them.

21 So anybody that has -- generally,

22 anybody that has three days or -- three days of


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1 eating, whether it’s a food record or recalls, they

2 have the eating occasions, but when you look at the

3 publications, that wasn’t their point of

4 examination, and so it was really about energy and

5 macronutrient composition and so forth.

6 And so we said there might be a lot of

7 retrospective analysis coming out from something

8 like this. But there is a lot of data, I think,

9 that’s there. It’s just not published in that

10 manner.

11 So even just recommending the thought of

12 thinking in terms of eating frequency, I think, can

13 be really helpful.

14 MEMBER ARD: Jamy Ard. So a couple of

15 thoughts related to this morning, and maybe some

16 integration from conversations yesterday. So I

17 think it’s a big deal that we actually have

18 all-cause mortality as an outcome, and we’ve got a

19 really nice body of literature related to that.

20 That is the ultimate outcome. Right?

21 And I think, you know, being able to speak to that

22 in a way that, you know, has a strong level of


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1 evidence behind it with regard to the grave is

2 something of an anchor point potentially.

3 And then, you know, building on that, if

4 we think of the diet pattern concept as being an

5 organizing theme that then, you know, goes from

6 that, right, it’s related to a very strong outcome.

7 Positive effects, consistently in with -- and from

8 Rick’s earlier question about this idea of being

9 able to quantity the dose response relationship,

10 and being able to give, you know, a sense of a public

11 health type of impact, in the same way, you know,

12 using blood pressure by 2 millimeters of mercury

13 across the population as these, you know, projected

14 large impacts on cardiovascular disease events.

15 You know, if we were able to, you know,

16 incorporate some type of assessment that says, you

17 know, we shift the population intake in this way,

18 and towards a healthier pattern, again whatever

19 it’s called, then that has the potential to have

20 these types of public health impacts on

21 chronic -- nutrition-related chronic disease and

22 longevity. I think that’s pretty important to be


116

1 able to try to get to.

2 MEMBER DAVIS: I think that it’s

3 important to note that, over the course of the

4 discussion today and yesterday, that there has been

5 very limited or insufficient evidence to answer

6 many of the questions that have been posed to us,

7 and which we’ve been asked to address.

8 So it’s very limited evidence, and so

9 this gives us an opportunity to provide the

10 scientific evidence for the questions that have

11 been posed and then to talk about the research needs

12 that the scientific community can address.

13 Where do we need to go in the next few

14 years to answer some of these questions so that

15 there will be the scientific information available

16 for the next Dietary Guidelines Advisory Committee?

17 MEMBER HEYMSFIELD: Actually, I had a

18 very similar comment, and I’ve been thinking, of

19 course, about frequency of eating, and I’m a

20 clinical investigator. And these are questions

21 you could answer in your sleep if you did a

22 randomized, you know, experimental study.


117

1 And why haven’t they been done? And

2 think about that a little bit more. Who would fund

3 something like that? The USDA should put some

4 money towards doing these kinds of studies because,

5 you know, you think about really what gets funded

6 in science, basic science, molecular mechanisms and

7 so on.

8 Very hard to get funding for doing a

9 study like that. So we depend on these huge

10 observational studies that have fuzzy data in them,

11 very hard to come to conclusions, but one good

12 really careful randomized trial like this, you

13 could answer a big question.

14 And there must be some other studies out

15 there, people thinking about this a lot, with

16 time-restricted eating and so on. There is

17 some -- a lot of data coming out like that. But I

18 think that we can encourage really good, careful

19 studies coming out of this type of work. That’s my

20 thought.

21 MEMBER SNETSELAAR: I also agree that

22 we need to find new places for funding, especially


118

1 for clinical trials. I think too -- and this is

2 echoing back to what Jamy said, but I was thinking

3 about this too before he actually mentioned it, the

4 idea of coming up with, you know, what I might call

5 some sound bites from our research, that would talk

6 about the public health impact of things that we’re

7 finding, I think, is incredibly important and

8 something you should think about.

9 MEMBER MAYER-DAVIS: So -- yeah. Beth

10 Mayer-Davis here. So I have a couple of thoughts

11 about what we will sort of do with our notion of

12 dietary patterns and the hierarchy of patterns,

13 foods, nutrients.

14 And there’s a couple of things I would

15 think, you know, for our Committee’s consideration,

16 as we continue to look at the literature, to look

17 at the studies, but with an idea to the dietary

18 pattern, the ways of eating, for the study, which

19 may not be the focus, but to be able to say, well,

20 what does it mean that this was a study conducted

21 in Italy, this was a study conducted in a small

22 community in rural America, you know, whatever it


119

1 might be, so that we sort of keep in our mind, you

2 know, what some of those implications might be,

3 which is, you know, not something that can be done

4 with, you know, scientific rigor, but I think it

5 would at least help us with our thinking.

6 But we need to get to more scientific

7 rigor with regard to this notion of patterns, and

8 there’s a couple of ways to do that, one of those

9 being advancing statistical methods to deal with

10 the hierarchy of nutrients, foods, and dietary

11 patterns.

12 So there have been, then, of a small

13 number of efforts towards this using methods like

14 structural equation modeling and so forth, and it’s

15 very challenging. I mean, I will say that my

16 research group has tackled some of this with some

17 really smart biostatisticians, which I am not a

18 biostatistician.

19 And you know, there are some real

20 challenges with that, but I do think that that’s an

21 area of research, you know, that, you know, really

22 would be very important, I think, at this juncture.


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1 One thing that we can do, you know,

2 possibly in the future for the next Dietary

3 Guidelines, because there’s only so much time in the

4 day for Regan’s committee to work, you know, would

5 be to think about, you know, in various

6 subpopulations, particularly subpopulations at

7 especially high risk for certain diseases like type

8 2 diabetes or certain populations where food access

9 is a problem, so groups with lower socioeconomic

10 status markers, to do some modeling in those groups

11 to understand, well, what would be the foods of

12 those that are actually consumed in those

13 particularly vulnerable populations that are

14 contributing to healthy or less healthy overall

15 dietary patterns, so that you can start to think

16 about some of this work would be translated relative

17 to public health impact and effect.

18 Another kind of practical thing is to

19 think about food labels. We had some discussion at

20 the break, thinking about really the utility or

21 potentially lack thereof for a nutrient-based food

22 label, and could that be complemented by


121

1 or -- getting really far out there -- replaced by

2 labels that are food-based to help people in making

3 decisions about food choices that aren’t grams of

4 carbohydrate, number of calories and so forth,

5 which in some individuals, that’s important

6 information, you know, but just to at least

7 complement that, you know, with maybe a much more

8 food-based approach, you know, thinking about

9 wanting to, you know, provide assistance in guiding

10 people with choices towards a healthier pattern.

11 You know, because you see some -- you

12 know, if you look at labels of some of these bars,

13 you know, and people are maybe are choosing all this

14 as a higher number of grams of protein, and this is

15 replacing my lunch, so I’m going to go for that, when

16 really the second ingredient is cane sugar, you

17 know, so I mean -- and common on these labels. I

18 confess I’ve looked at some of the labels too.

19 But I do think that, you know, the whole

20 purpose of this Committee is about Dietary

21 Guidelines for Americans and how can we provide, you

22 know, rigorous, science-based evidence, you know,


122

1 towards providing guidelines about what people

2 could eat and how, you know, federal food policies

3 can facilitate improved choices for people.

4 So those are just some of my thoughts

5 about how to, you know, get to this notion of dietary

6 patterns, both from a scientific perspective and

7 also from a perspective of implementation

8 eventually.

9 MEMBER BOUSHEY: I’ve really

10 appreciated these ideas that everyone has come up

11 with here, and it’s an enjoyable conversation to

12 listen to. I think I’ve gone over some of these

13 yesterday, but it just sort of screams out.

14 Our food supply is changing constantly

15 at the moment, and the Beverages group really

16 pointed that out, and I believe that we have to

17 somehow try to start a system of documenting exactly

18 what makes now a beverage, since we have more

19 beverages now that are beyond soda.

20 It’s an interesting phenomena. It’s

21 rather complex, but somehow, if we could get it

22 started, I think it will help moving into the


123

1 future, because I don’t see they’re going away.

2 And then with frequency of eating, I do

3 believe we have a responsibility to put in some

4 guidelines to make sure that they -- you know,

5 there’s some type of -- what would make the best

6 approach to doing frequency of eating?

7 And I do think that these mobile-based

8 methods that we just talked about a little bit ago,

9 you know, they can capture the frequency of eating

10 and they also will give you a time stamp, you know,

11 and so we weren’t able to get that time stamp, but

12 that’s the beauty of these mobile-based methods, if

13 you’re doing frequency of eating, all that can

14 indeed be recaptured.

15 No, I think that’s my last one. .

16 MEMBER DEWEY: Kay Dewey. Thanks very

17 much. I wanted to comment a little bit on the point

18 made, Rick, about that, as a whole, Americans don’t

19 spend a large portion of their income on food, but

20 there are people for whom it is a serious issue, and

21 I think for the healthy diets that you have looked

22 at in the Dietary Patterns subgroup, we really need


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1 to look at the cost of those diets and the

2 affordability for those that are low-income.

3 Some of the key foods like seafood are

4 expensive. For nuts other than peanuts, they tend

5 to be a bit expensive. Fruits and vegetables,

6 especially fresh versions. So I think it would be

7 a nice next step to work on the costing issue.

8 Some research groups are doing that, and

9 I think it’s a responsibility we have to address the

10 inequity in access to healthy diets in the U.S.

11 And then in terms of the dietary pattern

12 research as a whole, I’m thinking that it’s a little

13 circular, because many of the studies have said

14 here’s a healthy diet based on what we knew 10 years

15 ago, so we’re going to score you on that basis.

16 And then we’ll say, is that score

17 related to healthy outcomes? But that’s a score

18 based on previous research, and now we might know

19 more and we might score it differently.

20 So it’s a little hard for me to grasp

21 exactly how this sort of, rolling ball moves

22 forward, and one example of that is the saturated


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1 fat part of the equation.

2 I think there’s more research that is

3 sort of distinguishing different types of saturated

4 fat. They’re not all the same, and there’s some

5 interesting work on dairy fat from either milk or

6 cheese or yogurt.

7 And is it good or is it bad? Or you

8 know, how does it actually affect your body? And

9 then my favorite example is chocolate, which has

10 saturated fat, but I will maintain is a healthy

11 food, apart from the sugar.

12 And I’m just joking, obviously, but I

13 think --

14 VICE CHAIR KLEINMAN: I’m not.

15 MEMBER DEWEY: -- I think we do need

16 some research on different types of saturated fat

17 in order to really home in on our question. And

18 lastly, in terms of frequency of eating, one thing

19 I didn’t hear mentioned is the issue of the

20 macronutrient distribution within each eating

21 episode.

22 So I know that, for example, for


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1 pregnant women, one piece of advice is to have each

2 eating episode have a balance between fat,

3 carbohydrate and protein, that we don’t all

4 carbohydrate, especially for things like

5 gestational diabetes.

6 But I haven’t heard that mentioned yet,

7 and I think it’s something probably the next DGAC

8 would be able to look at, but I would like to hear

9 other people’s thoughts about that.

10 MEMBER DONOVAN: Sharon Donovan. I

11 guess I was thinking about, you know, the life

12 course sort of approach that we’re taking, and I

13 really am supportive of that. And Jamie’s gone

14 now, but her comment that, you know, our

15 teenagers, our teenage girls who are showing very

16 poor dietary patterns and intakes are our future

17 mothers.

18 And we have good biological

19 plausibility that health really begins in the womb

20 with epigenetics. As part of this Committee, we’re

21 not talking at all about microbiome, and that’s an

22 area that’s clearly emerging.


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1 By the next version, I think hopefully

2 we’ll have a better understanding of how

3 diet -- because that’s really at the nexus between

4 dietary intake and so many of our health outcomes.

5 And so I guess, there’s kind of two comments.

6 One, as we take our life course

7 approach, I really do want us to think about, you

8 know, starting at the very beginning, which

9 involves that gestating mother and her diet and her

10 pre-conceptual health, you know.

11 There’s a lot of data on that in terms

12 of obesity -- maternal obesity status and risk of

13 childhood obesity. So -- and I think our message,

14 as a government, should be that, you know, health

15 begins in the beginning, and that the healthier that

16 we could have our population and the better

17 consistent messages we can get, you know,

18 ultimately -- it may be a while before it pays

19 dividends, but we will -- we’ll see that.

20 But I also want to make a comment about,

21 as we brought in B-24, in particular, and pregnancy

22 and lactation, two things. These are unique needs,


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1 and so if we say that infants need a special kind

2 of diet, it’s because their needs, per kilogram body

3 weight or at a specific life stage or women during

4 pregnancy, are going to be different.

5 So if we, you know, talk about different

6 foods differently in these age groups, then there’s

7 a biological reason for that. So we need to

8 integrate, but we also need to understand these

9 unique needs, and we heard, for example, in the

10 elderly that maybe they’re not getting enough

11 protein.

12 So you know, working that in, and so you

13 know, that’s kind of where I’m thinking as we start

14 to integrate these new areas, how to integrate, but

15 also to maintain those unique needs, and how those

16 then can feed into public health recommendations,

17 and you know, programs to support -- and your

18 comment about, you know -- and mine yesterday about

19 food insecurity and thinking about the example of

20 a nice plate of salmon on it.

21 It’s, like, well, how many -- a

22 lot -- that’s a very expensive food for very many


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1 people, you know. So I think it’s our

2 responsibility to not just come up with the ideal

3 diet if it’s, first of all, not palatable for many

4 people, but we can train little kids to like foods

5 too. Right? One of the systematic reviews

6 involves even exposure in utero to flavors.

7 So you know, really, I want us to think

8 broadly. And I also want to say that, you know, for

9 our committees in particular, there’s a lot of

10 insufficient evidence for the specific questions

11 that we asked, but there’s still a lot of other

12 government recommendations and a lot of other

13 information out there about feeding children, and

14 those will certainly be, you know, worked into our

15 discussion.

16 So we’ll, you know, represent the

17 systematic reviews that we did, but we’ll be working

18 within the context of the broader knowledge in these

19 areas.

20 MEMBER BAILEY: I’ll echo a lot of that.

21 One thing I’ve been curious about is how we engage

22 people to make different food choices. So


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1 consistently, across time, we’ve identified

2 fruits, vegetables, whole grains, legumes -- for

3 you, John -- as foods to encourage, but looking at

4 the adherence to those, Americans aren’t eating

5 that way.

6 And so do we need to be working with

7 behavior specialists or other types of scientists

8 to help engage the public, especially given the

9 severity of the chronic diseases that we talked

10 about yesterday?

11 We really have to figure out some

12 strategies to get people to change.

13 MEMBER NAIMI: Tim Naimi, Boston

14 University. I think it’s been a really nice couple

15 of days of meetings. I think the information we

16 heard today from the Dietary Patterns provides a

17 really nice, possibly a nice kind of a unifying

18 theme, this idea about the pattern of the

19 consumption, you know, which is really about the

20 quality of the food and more nutrient-dense foods

21 is kind of -- trumps, you know, specific nutrients

22 or specific foods, in terms of its importance.


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1 And I think the good thing is that in

2 this area we do have, you know, relatively solid

3 data, not perfect, we could use some more randomized

4 trials. But -- and it’s a kind of -- that thing

5 about improving the pattern sort of works well

6 across, you know, a number of different -- using a

7 life course approach, it works well.

8 When you focus on disparities, because

9 again, a lot of these problems relate to improving

10 overall -- the overall pattern of the diet quality,

11 works well across all of those. And again, it works

12 well in terms of addressing nutrients of concern,

13 fats and salt and sodium and added sugars.

14 So I think it’s kind of a nice unifying

15 theme in an area about which there’s pretty good,

16 kind of, scientific agreement.

17 In terms of, you know, other things,

18 though -- in terms of helping the public, you know,

19 the idea of making things very concrete for people

20 or really -- if this is kind of our approach or a

21 unifying theme, how we kind of put flesh on the bone

22 for people in terms of thinking about changes that


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1 they could make.

2 But then in terms of, you know, actually

3 making changes, you know, as we know,

4 unfortunately, that knowledge is only a small part

5 of the equation, and you know, the saying that every

6 system is perfectly designed to get the results that

7 it gets.

8 The U.S. Dietary Pattern is -- you know,

9 is a perfect result of a system that, you know, is

10 based on the prices of various foods, the physical

11 availability of various foods, and all of these

12 factors.

13 And so whatever we contribute in terms

14 of a knowledge base also needs to inform how

15 policies change. Because I don’t think

16 that -- telling the public is not enough to make a

17 meaningful impact.

18 MEMBER NOVOTNY: Rachel Novtony. I

19 appreciate the Committee’s comments. The one

20 maybe additional area I’m thinking about is, you

21 know, as we look towards food patterning and -- or

22 challenges of how individually to do both the


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1 breaking down and the putting back together and

2 thinking about the methods for that, both for

3 recommendations for research, as well as the

4 important -- for communication to the public.

5 So back to -- are we thinking of an

6 expanded definition of food groups, now calling

7 them maybe food components, and how do we name those

8 and group them, and be sufficiently expansive and

9 inclusive but not overwhelming, and find words

10 that, you know, are inclusive for different groups?

11 Something about what that looks like.

12 And similarly, I guess in that vein,

13 thinking about the term nutrient-dense, you know,

14 how do we really convey that? Is there like an

15 index we could develop, again, both for research and

16 for communication.

17 How does someone in a store identify a

18 nutrient-dense food, or -- so just some of

19 the -- both practical -- the reality is, I think,

20 they have research implications, too, the more we

21 can develop these things and even develop some

22 commonalities and methodology so that we have a body


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1 of evidence to look at as we go forward. That’s what

2 I’m thinking about.

3 VICE CHAIR KLEINMAN: So I really

4 appreciate the framework concept that we’ve been

5 passing around the table around dietary patterns,

6 and I guess would come back to looking at how these

7 patterns change over the life course and perhaps

8 some conversation about priorities of different

9 stages of the life course.

10 So we’ve been talking about all-cause

11 mortality, and obviously, I’m pretty interested in

12 that, although it may be too late. But if we look

13 at it during pregnancy, for example, and lactation,

14 we’re really out to support mothers’ health, and

15 we’re out to support growth and optimal growth and

16 development in the baby.

17 If you look at it in the baby, we’re

18 trying to support optimal growth and development,

19 and that may actually be the first priority, at

20 least for most parents it is.

21 And that may coincide -- we may be able

22 to do that at the same time that we promote long-term


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1 health, but we should at least acknowledge that. And

2 there are natural periods of transition across life

3 stage: total dependence, independence, entering

4 school, leaving the home, entering the workforce

5 and so on.

6 And so if we could find a way to kind of

7 perhaps refine the conversation about dietary

8 patterns so that it appears that we considered it

9 as a continuous process that has somewhat different

10 priorities, although the approach may be the same,

11 and I think that is a way of relating what we’re

12 talking about to the consumer, either the parent,

13 the child, or the adult consumer.

14 So I think we’re moving closer and

15 closer to an integrated approach, and I really like

16 the way this is moving.

17 CHAIR SCHNEEMAN: I would agree

18 that -- I think these comments are very useful, and

19 I just hope I can figure out my notes when it’s all

20 said and done, because I’ve been trying to capture.

21 And I really appreciate the Committee

22 being focused on their own work, but at this point,


136

1 thinking about that work in relationship to what all

2 of the subcommittees are doing, because at the end

3 of the day, that’s where I think our report can have

4 its greatest impact, and not just each individual

5 scientific evaluation, but how does it come

6 together as a whole?

7 So I think we’re ready to take our lunch

8 break at this point. And we will start the public

9 comments at one o’clock when we come back, so I think

10 that’s -- that would fit well with the schedule,

11 since we had the opportunity for discussion right

12 now.

13 So those of you who will be giving -- I

14 know they’re going to rearrange the room, and there

15 will be a good process where we can go through, and

16 by starting a little bit early, I know we had some

17 people on the waiting list, but we might be able to

18 include some of those.

19 I’m looking back at Eve, and she’s

20 nodding her head. Okay. So we will be back and

21 starting at one o’clock. Thank you.

22 (A lunch recess was taken.)


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1 (1:02 p.m.)

2 MS. DE JESUS: Good afternoon. Okay.

3 I hope everyone had a good lunch? I’m Janet de

4 Jesus and, I’m the nutrition advisor at the Office

5 of Disease Prevention and Health Promotion with

6 HHS, and I’m going to introduce our public comment

7 session for this afternoon.

8 First, I just want to thank everyone

9 that came to give public comments. We really

10 appreciate your interest and input on the Dietary

11 Guidelines scientific process. We take it very

12 seriously.

13 We review all the online comments, and

14 we’re really happy to have you here in person to give

15 your comments. So individuals that have

16 registered to provide public comments will be able

17 to speak for three minutes.

18 We have 45 people on the list, and if

19 time permits, those on the waitlist will be able to

20 participate also. We have it divided among either

21 side of the room. So we’ll start with number one

22 and then alternate to the other side of the room for


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1 number two.

2 We have staff available that will help

3 usher the next speaker to the microphone, and then

4 we have a couple waiting to speak. So we have staff

5 here that will be timing you, and you’ll be able to

6 see the timer, and when it gets to the three minutes,

7 please promptly conclude your comments.

8 We’d appreciate that. And the

9 moderator here will call the next speaker. So

10 please be prepared when your number is called.

11 There’s no opportunity for question and answer with

12 the Committee today, as usual.

13 So once you’re finished, feel free to

14 either return to your seat, sit in another place,

15 or if you’d like to exit the auditorium, please do

16 in the rear of the auditorium. And on a final note,

17 this meeting is being recorded, so it will be

18 available after on DietaryGuidelines.gov.

19 So with that, I’ll now conclude and turn

20 it over to our moderator for the comment session.

21 Thank you.

22 MS. BROWN: Thanks, Janet. We’ll


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1 begin with commenter number one, please.

2 MR. DEVIRGILLIS: Raymond DeVirgillis

3 on behalf of Infant Nutrition Council of America.

4 The Infant Nutrition Council of America represents

5 companies that research, develop, and market

6 formulated nutrition products of infants, children

7 and adults.

8 We produce over 95 percent of the infant

9 formula consumed in the U.S. We take our

10 responsibility of providing optimal nutrition to

11 infants very seriously. We support the American

12 Academy of Pediatrics’ position that breast milk is

13 the preferred infant feeding option.

14 We also agree with the AAP and other

15 leading nutrition health and regulatory bodies that

16 infant formula that has been submitted to, reviewed

17 by, cleared by, and registered with the FDA is the

18 only safe, nutritious and recommended alternative

19 for infants who are not exclusively breastfed.

20 In 2019, INCA conducted an infant

21 feeding survey of over 1,200 mothers, fathers, and

22 other caregivers of infants under 12 months of age,


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1 seeking insights in to their beliefs, current

2 practices, and sources of information about infant

3 feeding.

4 The survey findings underscore how

5 important the recommendations for the B-24

6 population will be in the upcoming DGAs. This is

7 a critical opportunity to provide accurate

8 information to remove any stigma associated with

9 infant feeding decisions.

10 Based on the survey findings, it is

11 evident that parents and caregivers understand the

12 benefits of breastfeeding and most often introduced

13 formula feeding due to health reasons.

14 Additionally, the following messages are

15 imperative to communicate the final Guidelines.

16 Number one, in order to avoid the use of

17 homemade infant formula as well as formulas from

18 non-reputable sources, the DGAs must ensure that

19 parents and caregivers understand that the only

20 alternative to breast milk is infant formula that

21 has been submitted to, reviewed by, cleared by, and

22 registered with the FDA.


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1 Number two, the 2020 DGAs must

2 communicate the importance of parents and

3 caregivers discussing their feeding options with

4 their health care provider.

5 Number three, the DGAs should support

6 access to evidence-based information about breast

7 milk and infant formula feeding in order to allow

8 families to make the best choice for their baby.

9 Number four, for infants who are

10 exclusively breastfed, the DGAs should recommend

11 Vitamin D supplements to avoid risks related to

12 growth and development.

13 And number five, the DGAs should address

14 current nutrient gaps in the diets of older infants

15 and toddlers, and recognize the role of

16 complementary feeding products such as follow-on

17 formulas and oral nutrition supplements that can

18 help to close those gaps.

19 Finally, these DGAs must not stifle

20 infant formula innovation, as infant formula

21 companies are leaders in infant nutrition research

22 and their collective research has led to


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1

2

3

4

5

6

7

8

9

10

11

significant improvements in the health of

formula-fed babies.

We hope the DGAC, USDA and HHS will

consider the findings of 2019 infant feeding

survey. While the 2020 Guidelines must be based on

the highest quality of science, they must also lead

to practical recommendations that support safe and

nutritious infant feeding options.

Thank you for the opportunity to provide

these comments as well as our evidence-based

written comments.

12 MS. BROWN: Thank you.

13 Commenter number two?

14 MS. GARRISON: Good afternoon. My

15 name is Becky Garrison, here on behalf of the

16 American Pulse Association. Thank you to the

17 Committee for your work to inform the next Dietary

18 Guidelines.

19 First, I remind the Committee about the

20 opportunity to end decades-long confusion and

21 inaccuracy over legumes, the beans and peas, in

22 parentheses, terminology used in the previous


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1 guidelines.

2 Legumes are a broad group of plants

3 including soybeans, peanuts, fresh beans and peas,

4 whereas pulses are the narrow subset of legumes that

5 refer to the dry, nutritionally-dense, edible seeds

6 and beans, peas, lentils and chickpeas.

7 Pulses is the most specific and accurate

8 term that should be used in the Dietary Guidelines

9 to capture the food group that currently includes

10 kidney, pinto, white, lima, and black beans, split

11 peas, chickpeas, and lentils. We ask the Committee

12 to utilize the correct pulse terminology in its

13 report.

14 Secondly, pulses offer up to nine grams

15 of protein per serving, and are a good source of zinc

16 and B vitamins plus multiple underconsumed

17 nutrients like magnesium, choline, iron and folate.

18 They are also excellent sources of

19 potassium and dietary fiber, which are two

20 nutrients of public health concern. We ask the

21 Committee to highlight pulses’ many nutritional

22 benefits in its report.


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1 Moreover, multiple meta-analyses have

2 found a relationship between pulse consumption and

3 positive health benefits. These studies have

4 linked pulses to a decreased risk for heart and

5 cardiovascular disease and reductions in

6 cardiometabolic risk factors like blood pressure

7 and cholesterol.

8 Pulses are also associated with

9 decreased incidence of obesity and risk for certain

10 cancers. Importantly, these studies suggest a

11 dose response relationship between pulse intake and

12 related health benefits, meaning positive health

13 outcomes are seen within an intake around three cups

14 per week, or about one-half cup of cooked pulses per

15 day.

16 In line with this, the 2005 Guidelines

17 recommended three cups per week for the general U.S.

18 dietary pattern. Unfortunately, since then, the

19 past two Guidelines have only recommended one and

20 a half cups per week for the general U.S. dietary

21 pattern.

22 No scientific justification was given


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1 for this decrease in recommended servings. Based

2 on available evidence, we ask the Committee to

3 recommend at least three cups of pulses per week for

4 all dietary patterns.

5 In closing, we ask the Committee to

6 replace the confusing legumes with beans and peas,

7 in parenthesis, terminology to pulses or pulses and

8 soybeans. We also ask the Committee to recognize

9 the category’s unique nutrition benefits and to

10 increase the recommendation for pulses to three

11 cups per week for all dietary patterns.

12 Thank you again for your work and the

13 opportunity to comment.


15 Commenter number three?

16 MR. YOUNG: Good afternoon. I am Bill

17 Young, representing the Beer Institute, a national

18 trade association representing large and small

19 domestic brewers, beer importers, packaging

20 manufacturers, agricultural producers and other

21 suppliers of goods and services to the beer

22 industry.


146

1 Our members produce and import more than

2 85 percent of the beer consumed in the United

3 States. We believe the Dietary Guidelines are an

4 important and useful source of information for

5 legal-drinking-age consumers who weight the

6 well-known risks and benefits of alcohol beverage

7 consumption in the broader context of a healthy

8 diet.

9 Accurate and applicable moderate

10 drinking guidance is critical in this regard. We

11 would like to raise four points.

12 First, we urge continuation of the clear

13 advice and examples provided in the 2015 U.S.

14 Dietary Guidelines. It’s stated that if alcohol is

15 consumed, it should be in moderation, up to one

16 alcohol drink equivalent for women and up to two per

17 day for men. One alcohol drink equivalent contains

18 14 grams, .6 fluid ounces, of pure alcohol.

19 2015 was the first time the Dietary

20 Guidelines emphasized variability in drinks and

21 introduced them to the term, drink equivalent,

22 which we believes helps better track how much


147

1 alcohol they consume and sends an important message

2 that not all drinks are the same.

3 Second, we encourage the 2020 U.S.

4 Dietary Guidelines to again promote the vast

5 variability of alcohol beverages, including the

6 different in types, sizes and alcohol content of

7 beverages in the market.

8 The consuming public needs practical

9 and pragmatic information to make informed

10 decisions about the alcohol beverages they consume.

11 Third, we encourage the guidelines to

12 advise people to avoid consuming alcohol on an empty

13 stomach -- food slows the absorption rate of alcohol

14 beverages -- and to stay hydrated with water or

15 other non-alcohol beverages with consuming alcohol

16 beverages.

17 Four, the Beer Institute believes the

18 Dietary Guidelines should advise that there are

19 some people should not drink alcohol beverages at

20 all.

21 Those who are under 21, women who are

22 pregnant or have a medical or family history of


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1 concern should be cautioned against drinking. Any

2 person who has a concern about consuming alcohol

3 should consult with their health care provider for

4 guidance.

5 The Beer Institute members remain

6 steadfast in their commitment to promote

7 responsible consumption and reduce harmful use.

8 Members work diligently to prevent sales to minors

9 and reduce drunk driving, and are in the process of

10 implementing the voluntary disclosure initiative

11 to provide consumers with information about

12 calories, carbs, protein, fat, alcohol content and

13 freshness dating on packaging labels, and a full

14 list of ingredients on labels or websites.

15 This work adds to our responsible

16 marketing codes, and decades of member company

17 programming, encouraging consumers to drink

18 responsibly.

19 We hope these comments will inform the

20 work of this Committee and the staffs at HHS and

21 USDA, and we look forward to your expert report.

22 MS. BROWN: Thank you. We’ll now have


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1 commenter number four.

2 DR. KENDALL: Karima Kendall, Calorie

3 Control Council. The Calorie Control Council is an

4 international association representing

5 manufacturers of low- or no-calorie sweeteners,

6 food and beverages, as well as manufacturers and

7 supplies of low-calorie ingredients, including

8 dietary fiber and sweetener.

9 CCC has provided feedback previously on

10 DGAs, including noting the importance of

11 communicating information on diet, physical

12 activity, and weight control in achieving and

13 maintaining a healthy lifestyle.

14 When making recommendations, it is

15 important that the Committee consider the evidence

16 regarding the utility of low-calorie ingredients,

17 including low-calorie sweeteners and dietary

18 fibers in managing weight and achieving a

19 healthy, balanced diet, by way of reducing added

20 sugar and calories from the diet.

21 CCC agrees with the recommendation

22 previously made that the DGAs should better reflect


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1 language used in scientific literature related to

2 LNCS.

3 As noted by Committee member, Dr.

4 Richard Mattes, the terms high-intensity sweetener

5 and artificial sweeteners are not technically

6 correct. Therefore, CCC supports the proposal to

7 standardize the term low- or no-calorie sweeteners,

8 and LNCS, when referring to these ingredients.

9 As noted in previous DGAs in Committee

10 meetings, dietary fiber continues to be a nutrient

11 of concern. This fiber gap presents an opportunity

12 for the Committee to make stronger recommendations

13 about the importance of a high-fiber diet in

14 improving the health of Americans.

15 The CCC is pleased with the progress of

16 the FDA in updating its definition of dietary fiber

17 and determining those ingredients that meet this

18 definition. However, significant advancements in

19 food technology allow for fiber enrichment of a

20 variety of foods, including those that are

21 inherently low in fiber.

22 Future Guidelines should note the


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1 expansion of fiber-rich options and their important

2 role in helping increase total fiber intake with

3 minimal impact on calories. As with other

4 nutrients of concern, simply meeting daily food

5 group recommendations does not guarantee adequate

6 intake.

7 We support recommendations to consume

8 more fiber from a variety of sources, including

9 fiber-enriched products, using nutrition fact

10 label and ingredient lists as a guide. We also

11 encourage the evaluation of extrinsic and intrinsic

12 dietary fibers by the same standards as both play

13 a role in dietary patterns.

14 In the evaluation we should consider the

15 role of both fibers in the diet and how they help

16 to close the fiber gap. Lastly, emerging research

17 indicates that prebiotic fibers alters the gut

18 microbiome and offers additional means to enhance

19 calcium absorption.

20 Future recommendations should review

21 dietary patterns that are broader than consuming

22 cereals, grains, fruits, vegetables, and fit into


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1 dietary patterns. We thank you for your

2 consideration of these comments, and please

3 recognize that low- and no-calorie sweeteners and

4 fibers help in the management of certain conditions

5 and are critical to the dietary patterns.

6 Thank you.

7 MS. BROWN: Thank you. Now, commenter

8 number five?

9 MS. DOCKTER: My name is Berit Dockter,

10 and I represent the Healthcare Nutrition Council.

11 Thank you for the opportunity to provide comment

12 today. HNC is an association representing

13 manufacturers of enteral nutrition formulas and

14 oral nutrition supplements, parenteral nutrition

15 formulas, supplies and equipment.

16 We are committed to improving health by

17 advancing policies that address and raise awareness

18 to nutrition and its impact on patient outcomes and

19 health care costs.

20 Today, I will highlight a few points HNC

21 would like the Dietary Guidelines Advisory

22 Committee to consider when determining


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1 recommendations for the Dietary Guidelines for

2 Americans.

3 In step with the timing of the World

4 Health Organization Decade of Healthy Aging

5 starting in 2020, we know we cannot have healthy

6 aging without good nutrition. HNC supports the

7 USDA and HHS approach to differentiate between life

8 stages in the Dietary Guidelines, and that older

9 adults, age 65 and older, remain a separate life

10 stage, as identified.

11 We are concerned about the prevalence of

12 malnutrition, especially among older adults, and

13 would like you to consider setting specific Dietary

14 Guidelines for this population in order to address

15 their needs.

16 As an example, to support our position,

17 studies have shown the protein requirements based

18 on the existing recommended dietary allowance

19 defined the same for ages 19 to over 70 years may

20 not be sufficient to meet the needs of older adults,

21 especially those recovering from hospitalization,

22 illness, surgery, falls and fractures, who may


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1 require a higher protein intake.

2 In order to address these nutritional

3 needs, oral nutrition supplements are often

4 recommended or prescribed by a physician or

5 registered dietitian . In some cases, people rely

6 on oral nutrition supplements as their sole source

7 of nutrition.

8 The World Health Organization has

9 published a strong recommendation that oral

10 nutrition supplements with dietary advice should be

11 recommended to older people affected by

12 undernutrition.

13 Oral nutrition supplements are used in

14 a range of ages and issues, which may include

15 failure to thrive in children, or addressing

16 sarcopenic obesity in adults. For children ages

17 one year of age and older with differentiated health

18 and nutritional needs, these products play an

19 important role in complementing the diet of a

20 specific population and can support growth and

21 development.

22 Considering all these elements, the


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1 Healthcare Nutrition Council would like to

2 recommend the adoption of specific nutritional

3 recommendations for older adults, including

4 optimization of protein intake, and that the

5 Committee considers the role of oral nutrition

6 supplements as a practical way to complement the

7 diet of individuals of any age who are unable to meet

8 their nutritional needs through regular foods

9 alone.

10 Thank you for reviewing our comments

11 submitted to the docket.

12 MS. BROWN: Thank you. Now, commenter

13 six?

14 DR. LAYMAN: I’m Don Layman, professor

15 at University of Illinois. I’d like to speak about

16 the importance of flexibility in Dietary Guidelines

17 and food choices, especially related to protein.

18 The dietary reference intakes provide

19 science-based ranges for safe and adequate nutrient

20 intakes. The 2015 Advisory Committee recognized

21 the need for flexibility in diet choices.

22 They provided three examples of healthy


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1 diets, including vegetarian diet, Mediterranean

2 diet, and the U.S. omnivore diet. These diets

3 provide individuals with both food and protein

4 choices.

5 Currently, there’s a narrative for more

6 plant-based diets, but all these diet models reduce

7 food choices and reduce the quantity, quality and

8 bioavailability of protein. The net impact of

9 these combined changes on our health is unknown.

10 We can create theoretical diets that

11 appear adequate, but the extrapolation that aging

12 and sedentary Americans or lower-income adults can

13 implement healthy plant-based diets remains

14 speculative at best.

15 There are three key facts about protein

16 that impact diet choices. The first, a daily

17 protein requirement is an absolute amount based on

18 lean body mass. Current Dietary Guidelines

19 misrepresent protein as a percentage of energy

20 intake.

21 Protein is the only essential

22 macronutrient that needs to be defined as grams per


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1 kilogram body weight. Therefore, protein needs

2 are inversely related to calories. For example,

3 older and sedentary adults with reduced energy

4 needs still require at least the same amount of

5 protein, meaning the protein must be a much higher

6 percentage of total calories, perhaps at the upper

7 bound of the AMDR.

8 The other two related factors are age

9 and physical activity. Beginning in our 30s, the

10 efficiency of protein utilization to maintain

11 muscle health begins to decline, producing well

12 characterized, age-related loss of muscle mass,

13 strength, and metabolic health.

14 This age-related loss of functional

15 mobility and metabolic health can be mitigated by

16 correct choices about dietary protein and

17 resistance exercise. The worst-case scenario is

18 an older, sedentary adult consuming a low-protein

19 diet based on Dietary Guidelines expressing protein

20 as a percentage of calories.

21 I urge the Committee to continue with

22 the initiative of the 2015 Committee to recognize


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1 there are multiple ways to create healthy diets and

2 to more fully integrate current knowledge about

3 protein and the full range of the AMDRs into the 2020

4 Guidelines.

5 Thank you.


7 Now commenter number seven.

8 MS. BACKUS: Good afternoon. I am

9 Susan Backus, representing the Foundation for Meat

10 and Poultry Research and Education, a nonprofit

11 organization which studies ways the meat and

12 poultry industry can produce better, safer products

13 and operate more efficiently.

14 The Foundation is managed by the North

15 American Meat Institute and is a contractor to the

16 Beef Checkoff. Meat and poultry products play an

17 important role in healthy, balanced dietary

18 patterns.

19 One of the primary benefits of including

20 meat and poultry in the diet is that consumers can

21 more easily fulfill their nutrient requirements.

22 However, the perceived lack of health benefits and


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1 potential adverse health outcomes are at the center

2 of many scientific studies.

3 Among the issues further clouding the

4 debate are confusion, misinformation and a

5 misunderstanding of how meat is processed. To help

6 demystify processed meats, the Foundation prepared

7 a white paper detailing common processed meat

8 products and ingredients, as well as nutrition

9 benefits and public health implications.

10 All foods require preparation and

11 processing to varying levels, and meat may simply

12 be the primary ingredient in a product, just as

13 flour is the base ingredient in a host of cereal,

14 bakery, and pasta products.

15 Meat preparation for consumption

16 generally includes cutting meat into smaller sizes

17 and adding non-meat ingredients in cooking.

18 Generally, the main ingredients used in preparing

19 many processed meats are water, salt, nitrate,

20 phosphates, sugars, and fat, all of which are

21 recognized as safe by the Food and Drug

22 Administration.


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1 Many ingredients serve multiple

2 purposes. They can be used for flavor,

3 functionality, enhanced nutrition profile, and

4 microbial safety. Several processing techniques

5 can be used when preparing these products.

6 Processed meat and poultry products can

7 be smoked, dried, cured, cooked and marinated,

8 among other processes, which can add flavor,

9 texture or can act as a preservation to extend a

10 product’s shelf life.

11 Common processed meat and poultry

12 products are deli meats like roast beef, turkey and

13 ham or products like bacon, sausages and salami.

14 Each product can be prepared with different

15 ingredients and product formulations.

16 Nutrient needs vary widely due to each

17 individual’s disease status, age, preference, and

18 there are processed meat and poultry products

19 available to meet everyone’s individual nutrient

20 and lifestyle needs.

21 In fact, there’s a product center on

22 MeatandPoultryNutrition.org, which is a guide to


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1 help consumers and health professionals find

2 prepared meat products fitting particular

3 nutrition profiles, like low fat and reduced

4 sodium, among other regulated claims.

5 Meat and poultry products, including

6 processed meats, provide consumers with a

7 convenient, direct and balance dietary source of

8 all essential amino acids. Processing extends the

9 shelf life to an otherwise perishable food, reduces

10 waste with the use of all cuts of meat, and provides

11 consumers with convenience, flavor and cultural

12 identity.

13 A greater understanding of the science

14 of how processed meats are prepared and the safety

15 of the component ingredients will help demonstrate

16 their role in a healthy, balanced dietary pattern.

17 The Foundation will submit the white

18 paper for your consideration in February. Thank

19 you.


21 commenter number eight.

22 DR. JACK: Good afternoon. I am Dr.


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1 Maia Jack, vice president of science and regulatory

2 affairs at the American Beverage Association, ABA,

3 the trade association representing the

4 non-alcoholic beverage industry.

5 ABA strongly supports the work of this

6 Committee and is grateful for the opportunity to

7 provide input to Committee members as they begin

8 their important task of developing recommendations

9 for diets that promote health and reduce the risk

10 of chronic disease.

11 ABA shares the goal of USDA and HHS to

12 achieve energy balance in the American diet for all

13 Americans, including individuals who are

14 overweight and obese. To that end, ABA and its

15 member companies have introduced several voluntary

16 and ambitious initiatives.

17 For example, we have placed prominent

18 calorie counts on the front of all of our packages,

19 and in 2014, ABA partnered with the Alliance for a

20 Healthier Generation on a nationwide initiative to

21 reduce beverage calories consumed per person

22 nationally by 20 percent.


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1 We wish to share four points. First,

2 all foods, including sugar-sweetened beverages,

3 can be part of a balanced diet. To help consumers

4 moderate the sugar they get from beverages, we are

5 offering more beverages in smaller portion sizes

6 and greatly expanded beverage options with less

7 sugar or no sugar.

8 In 2013, the Academy of Nutrition and

9 Dietetics stated that proactive, empowering and

10 practical messages that emphasize a total diet

11 approach promote positive lifestyle changes.

12 Also, in 2014, McKinsey Global Institute reported

13 that interventions like smaller portion sizes have

14 the most overall and cost-effective impact on

15 obesity.

16 We encourage the Committee to support a

17 framework that prioritizes food choice over food

18 restriction. Beverages are generally important

19 for hydration, and beverages such as juices and

20 dairy contribute important nutrients.

21 ABA supports FDA and DGAs in the 2015

22 DGAs’ added sugar target of 10 percent of total


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1 calories. CDC data and other recent publications

2 on 15-year trends continue to show significant

3 declines in sugar-sweetened beverage consumption,

4 while obesity prevalence continues to rise.

5 Sugar-sweetened beverages are

6 contributing are less to overall dietary sugar and

7 added sugar, due in part to industry’s innovation

8 in providing a wide range of beverage options and

9 smaller-portion packaging.

10 Second, as noted in ABA submissions of

11 May 9, July 22 and August 13, growing evidence

12 supports low- and no-calorie sweetened beverages as

13 one possible tool to assist consumers in weight

14 management.

15 Public Health England acknowledges the

16 positive role of low- and no-calorie sweeteners and

17 sugar reduction in weight maintenance, and the

18 European Food Safety Authority recognizes they are

19 of value for blood sugar control.

20 Research also shows that consumers of

21 low- and no-calorie sweetened beverages have

22 improved diet quality, due to lower sugar intakes.


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1 These beverages are also equivalent to water in

2 overall weight management, as supported by

3 published research.

4 Third, as caffeine has been included for

5 consideration as a food component, it is worth

6 noting, as the ABA submitted previously, that

7 numerous caffeinated beverage intake assessments

8 show caffeine levels at or well below the accepted,

9 safe, moderate range of 400 milligrams per day from

10 all sources. We urge the Committee to consider

11 caffeine holistically from all sources.

12 Finally, beverage categorization

13 should be based on similar characteristics to

14 minimize confounders from other calorie sources

15 when interpreting findings. For the Committee’s

16 reference, the ABA proposed a framework in its

17 August 13 submission.

18 In summary, the ABA and its member

19 companies are committed to practices that provide

20 transparent and accurate information about its

21 beverages.

22 Thank you.


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2 Commenter number nine?

3 MS. GRAHAM: Good afternoon. Thank

4 you for the opportunity to comment. My name is

5 Allie Graham, and I’m here today on behalf of the

6 National Potato Council, or NPC, that provides a

7 unified voice for the U.S. potato growers, and

8 represents the interests of the U.S. potato

9 industry on national issues.

10 Potatoes are a nutritional powerhouse

11 that are a good source of eight different vitamins

12 and minerals for human health, including fiber and

13 potassium, two of the nutrients of concern as

14 identified by the 2015 DGAs.

15 Research shows that potatoes can serve

16 as a springboard vegetable, meaning when served, a

17 wider variety of vegetables are consumed. Despite

18 these benefits, potatoes are classified as a

19 starchy vegetable, which has become disparaging

20 term with repercussions across federal feeding

21 programs.

22 We believe that this is based on the


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1 premise that carbohydrate quality of white potatoes

2 is somehow inferior to other vegetables. In

3 studies examining specific foods within dietary

4 patterns, potatoes are sometimes placed in same

5 category as are refined grains, candies and

6 desserts, leading researchers to conclude that

7 white potatoes are not a healthy food choice.

8 Many healthy dietary patterns,

9 including Mediterranean diet, feature potatoes as

10 a staple vegetable. Because of their nutrient

11 density and evolving research in carbohydrate

12 quality, NPC recommends that the Committee

13 reevaluate the categorization of a starchy

14 vegetable and consider consumption of quality

15 carbohydrates when evaluating research within

16 systematic reviews.

17 Potatoes also play an important role

18 across the life stages. For example, one medium

19 white potato offers key nutrients during pregnancy,

20 including vitamin B6, C, folate, potassium and

21 dietary fiber.

22 Recent research in children indicates


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1 that potato consumption can influence cognitive

2 performance and satiety at increased levels,

3 compared to other carbohydrates such as rice or

4 beans. NPC recommends the Committee recommend

5 potato consumption across the life stages.

6 Finally, most potato products are

7 minimally processed, with some containing as few

8 ingredients as three ingredients: potatoes, oil

9 and salt. Food processing isn’t essential to

10 promote quality and safety of products, and there’s

11 little research to show long term benefits of

12 limiting processed foods on nutritional status.

13 Categories within the processing

14 classification systems, like NOVA, discourage

15 healthier product innovation, because it’s often

16 not possible to reformulate out of categories, such

17 as ultraprocessed.

18 NPC urges the Committee to exclude

19 studies from systematic review that focus on

20 categorization of foods solely based on processing.

21 In closing, potatoes are a

22 nutrient-rich vegetable that fit within multiple


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1 healthy dietary patterns, including plant-based.

2 Given their versatility and

3 affordability, potatoes can provide much-needed

4 health benefits across socioeconomic groups. As

5 such, we ask the Committee to recognize the

6 nutritional benefits of potatoes in the 2020-2025

7 DGAs.

8 Thank you for your consideration. More

9 detailed information is included in our written

10 comments. Thank you.


12 Next, we’ll have commenter number 10.

13 MS. REINHARDT: Thank you. Good

14 afternoon. My name is Sarah Reinhardt. I’m a

15 public health dietician and a lead analyst of food

16 systems and health at the Union of Concerned

17 Scientists in Washington, D.C.

18 I want to thank the members of the

19 committee for lending your time and your expertise

20 to this process. Thank you to the staff at the USDA

21 and HHS for the hard work that you do to make this

22 process transparent and accessible to the public.


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1 I know it’s a lot of time.

2 The stated goal of the Dietary

3 Guidelines for Americans is to make recommendations

4 about the components of a healthy and nutritionally

5 adequate diet, to help promote health and prevent

6 chronic disease for current and future generations.

7 I’m here today to ask the Committee to

8 fulfill its obligation to protect the health of

9 future generations by evaluating the scientific

10 basis for sustainable diets and incorporating its

11 findings into the scientific report.

12 The 2015 Dietary Guidelines Advisory

13 Committee, in its rigorous review of the evidence

14 on the relationship between dietary patterns,

15 sustainability, and food security found that a diet

16 higher in plant-based foods, such as vegetables,

17 fruits, whole grains, legumes, nuts and seeds and

18 lower in calories and animal-based foods is more

19 health-promoting and is associated with less

20 environmental impact than is the current U.S. diet.

21 Though dismissed amid political

22 controversy, these findings remain relevant and


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1 provide a foundation from which the current

2 Committee may draw conclusion. However, the last

3 five years have also seen rapid growth and research

4 on healthy and sustainable diets.

5 Because the present Committee was

6 precluded from updating the systematic review on

7 this topic, my colleagues at the Union of Concerned

8 Scientists and the Friedman School of Nutrition

9 Science and Policy undertook this task ourselves.

10 Closely replicating the methodology

11 described in the scientific report of the 2015

12 Dietary Guidelines Advisory Committee, we

13 evaluated the body of scientific literature on

14 dietary patterns, food sustainability, and food

15 security to identify relevant studies published

16 between July 2015 to September 2019.

17 Our results now under scientific peer

18 review include 22 relevant studies on U.S. dietary

19 patterns alone. Our results broadly support the

20 key findings of the 2000 Committee, but they

21 challenge them on one key conclusion.

22 Of nine studies explicitly comparing


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1 the current average U.S. diet to the healthy U.S.

2 style diet recommended by the Dietary Guidelines,

3 a majority found that the healthy U.S. style diet

4 is not inherently more sustainable.

5 And what that means is this: If the

6 federal government publishes and promotes Dietary

7 Guidelines but disregard sustainability research,

8 the diet it recommends today would put a healthy

9 diet out of reach tomorrow.

10 In its forthcoming report, I urge the

11 Committee to review and report findings based on the

12 current body of scientific research on sustainable

13 diets, including the systematic review by the 2015

14 Committee and the recent update we’ve completed,

15 which will be submitted to the public record for the

16 Committee’s consideration.

17 Thank you.


19 We’ll now have commenter number 11.

20 DR. DUBOST: Good afternoon. I’m Dr.

21 Joy Dubost, head of nutrition at Unilever North

22 America. We appreciate the Committee examining


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1 beverages in the context of dietary patterns and

2 would like to highlight two recently published

3 studies related to beverages and specifically

4 unsweetened tea.

5 First, we believe there is a gap in the

6 current Dietary Guidelines in providing clear,

7 overarching guidance and more specific

8 recommendations on beverage consumption. The

9 current Guidelines are limited by not fully

10 detailing specific types and amounts that should be

11 consumed as part of a healthy dietary pattern.

12 This would include beverages that not

13 only achieve nutrient and food group

14 recommendations, but also provide vital nutrients

15 such as flavonoids, which have demonstrated

16 clinical significance.

17 We would like to bring to your attention

18 the recently published manuscript and advances in

19 nutrition entitled, "The Role of Beverages as a

20 Source of Nutrients and Phytonutrients."

21 Based on observational studies,

22 randomized clinical controlled trials, and


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1 meta-analyses, the authors highlighted the role

2 beverages can play as part of the Dietary Guidelines

3 and considered beverages not traditionally

4 included, such as those that are

5 phytonutrient-dense, including unsweetened tea,

6 which is one of the best sources of flavonoids in

7 the diet. The authors noted the multiple benefits

8 of consuming tea, including reduced risk of

9 cardiovascular disease mortality.

10 A key point brought forth is, although

11 these compounds lack a DRI, their amounts from

12 fruits, vegetables, whole grains fall short of such

13 beneficial effects.

14 Eight ounces of unsweetened tea, being

15 major contributors of these phytonutrients,

16 provide amounts exceeding that found in one cup of

17 commonly consumed fruits and vegetables. The

18 authors recommended replacing sugar-sweetened

19 beverages with unsweetened tea.

20 Considering the current mean intake of

21 added sugars in the United States is significantly

22 higher than recommendations, substitution of one


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1 eight-ounce sugar-sweetened beverage with

2 unsweetened tea would bring these averages

3 significantly below the recommended added-sugar

4 limits while providing flavonoids.

5 We recommend that USDA and HHS provide

6 healthy beverage guideline, including those that

7 deliver bioactive components associated with

8 optimal health. We would also recommend a "my cup"

9 to accompany "my plate" to empower consumers to make

10 smart beverage choices.

11 Second, sponsored research by Unilever

12 was published in the Journal of Nutrients. This

13 explored tea consumption and seven other beverage

14 categories that relate to individual dietary

15 quality as well health outcomes. The findings are

16 very notable, and we’ll be providing this via

17 written comment.

18 Overall we saw beverage patterns that

19 were associated with dietary choices that included

20 a significantly lowered consumption of

21 high-calorie beverages, alcohol and added sugars.

22 In addition, daily unsweetened tea


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1 consumption is associated with a statistically

2 significant higher HDL and BMI in adults. We

3 appreciate your time and we’ll be submitting these

4 comments in writing.

5 Thank you.


7 Next, commenter number 12.

8 MS. SILVERMAN: Good afternoon. My

9 name is Jessi Silverman. I am a policy associate

10 and registered dietician at the Center for Science

11 in the Public Interest, a nonprofit consumer

12 advocacy organization that provides science-based

13 food and nutrition advice.

14 We led efforts to eliminate artificial

15 trans fat from the food supply, secure the nutrition

16 facts label and added sugar disclosure comment,

17 provide calorie labeling on chain restaurant menus,

18 improve school lunches, and remove sugary drinks

19 from schools.

20 On behalf of CSPI, thank you for the

21 opportunity to talk with you today about nutrition

22 for pregnant and lactating women, infants and


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1 children under two years of age. CSPI’s written

2 comments include our complete set of

3 recommendations regarding these life stages, and

4 today I will highlight four of them.

5 First, the best available evidence

6 supports advising women to consume a similar

7 dietary pattern during pregnancy and lactation, as

8 recommended by the 2015 Dietary Guidelines for the

9 general adult population: higher in vegetables,

10 fruits, whole grain, nuts, legumes, low-mercury

11 fish, low-fat dairy or nutritional equivalent

12 alternative, and vegetable oils and lower in red and

13 processed meats, refined grains, added sugar,

14 sodium and saturated fat.

15 Consistent with advice of other public

16 health experts, we urge the Committee to recommend

17 that pregnant women, infants and young children

18 avoid sugary drinks and other sources of added

19 sugars -- excess added sugars. Excuse me.

20 Second, CSPI urges the Committee to

21 consider minimizing the harms of mercury exposure

22 and maximizing the nutritional benefits of seafood


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1 consumption during pregnancy and lactation to

2 protect the neurocognitive development of the

3 infant.

4 To balance these considerations,

5 consumer need clear, focused advice to choose these

6 fish, and don’t choose these fish, such as the list

7 compiled by CSPI, referenced in our comments.

8 In addition, the EPA’s current

9 reference dose for limiting mercury exposure is

10 almost 20 years old. Taking into account recent

11 scientific evidence, one-half the current

12 reference dose is the highest level of mercury

13 exposure that should be tolerated until the EPA’s

14 new risk assessment is completed, particularly

15 given the developmentally sensitive nature of

16 pregnancy and lactation.

17 Third, Hispanic Americans should be

18 priority populations for tailoring prenatal folic

19 acid advice in a culturally appropriate manner.

20 Hispanic Americans experience a relatively high

21 prevalence of folic acid preventable spina bifida

22 and anencephaly.


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1 While many Americans mothers-to-be

2 consume folic acid from enriched cereal grains

3 because of mandatory fortification requirements

4 for these products, fortification of corn masa

5 flour, a common staple of Hispanic Americans’ diet,

6 is voluntary and rare.

7 Finally, we ask the Committee to

8 recommend safe limits on infant consumption of rice

9 cereal to protect children from exposure to

10 inorganic arsenic, which is associated with

11 impaired intellectual development.

12 More than half of infant rice cereals

13 tested by the Food and Drug Administration contain

14 inorganic arsenic at levels equal to or greater than

15 the agency’s proposed limit. Caregivers need a

16 guidance to limit rice and offer other

17 iron-fortified cereal grains, as recommended by the

18 American Academy of Pediatrics, the FDA and others.

19 Thank you.

20 MS. BROWN: Thank you. Commenter

21 number 13?

22 MS. OHLHORST: Sarah Ohlhorst, on


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1 behalf of the American Society for Nutrition. ASN,

2 a professional society with more than 7,000 members

3 who advance excellence in nutrition research and

4 practice, appreciates the opportunity to provide

5 input to the 2020 DGAC.

6 ASN emphasizes the importance of the

7 strength of the evidence to drive dietary guidance,

8 particularly as all new recommendations are

9 developed for ages birth to 24 months, B-24, and for

10 women who are pregnant and/or lactating.

11 Making B-24 recommendations that are

12 practical to meet the needs of today’s families and

13 caregivers is vitally important, as is basing B-24

14 recommendation on the overall balance of scientific

15 evidence.

16 As the Committee looks at beverage

17 consumption, recommendations regarding the

18 importance of water consumption as part of healthy

19 dietary patterns is of particular importance for

20 these subgroups.

21 We also urge the Committee to address

22 the nutritional status of women prior to


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1 conception, as well as the different nutritional

2 needs during pregnancy for age groups such as

3 adolescence and advanced maternal age.

4 Of equal importance, the Committee

5 should prioritize that practical, evidence-based

6 nutrition guidance be established for the rapidly

7 growing aging population. A recent U.S.

8 Government Accountability Office report

9 recommended that the 2025-2030 DGAs focus on the

10 nutritional needs of older adults, but we shouldn’t

11 wait until then.

12 Although modern medicine has increased

13 the life span, the incidence of disease does not

14 decrease as we age. Up to half of all older adults

15 are at risk of malnutrition, and nearly 25 percent

16 of those in their 60s and older have sarcopenia.

17 A continued focus on shortfall

18 nutrients, such as dietary fiber, particularly for

19 the aging population, is important, as well as

20 information on the various sources and practical

21 ways Americans can fill these gaps.

22 Nutrition research provides the


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1 strength of the scientific evidence upon which

2 answers to the DGAC’s questions can be built.

3 Therefore, ongoing and future nutrition research is

4 of utmost importance to the development of the DGAS.

5 Nutrition research will also help us

6 investigate the important research needs and gaps

7 identified by the DGAC. As a nation, we need

8 continued support for the key national sources of

9 dietary intake data, including NHANES, USDA’s

10 Economic Research Service reports, and the dietary

11 reference intake, without which we cannot

12 sufficiently develop DGAs.

13 A lack of dedicated support for

14 nutrition research stifles both the development of

15 the DGAs, as well as the next generation of

16 nutrition scientists who will make up future DGACs.

17 We encourage the DGAC to reference in its final

18 report the importance and need for ongoing support

19 for nutrition research and dietary intake data to

20 continue to produce relevant DGAs.

21 Thank you.



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1 number 14.

2 MR. JONES: Good afternoon. I’m Chris

3 Jones, director of marketing and strategy, here

4 speaking on behalf of the National Pork Board and

5 the more than 65,000 U.S. pig farmers that we

6 represent.

7 As the Committee continues to work

8 toward assembling a technical report to inform the

9 2020 Dietary Guidelines for Americans, we look to

10 again offer the following considerations regarding

11 the role of lean meat, including pork, in a healthy

12 diet.

13 Beginning with infants and toddlers,

14 pureed meat is a nutrient-rich option for a first

15 primary food in complementary feeding. Research

16 demonstrates positive effects on a proportionate

17 growth, micronutrient intake and developmental

18 milestones.

19 For children and adolescence, lean meat

20 offers high-quality protein to support proper

21 growth and development. A protein-rich breakfast

22 has shown to help with weight management and


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1 glycemic control in adolescents, and protein foods

2 that also provide iron, zinc and B vitamins, like

3 lean meat, are crucial for active brains.

4 In adults, there’s a growing body of

5 evidence that shows that lean, high-quality protein

6 like pork could benefit weight, heart health, and

7 Type 2 diabetes. During pregnancy and lactation,

8 adequate amounts of protein are crucial for a baby’s

9 growth.

10 Lean pork also provides Vitamin B12 and

11 highly bioavailable iron, two more nutrients that

12 support the health of both the mother and baby

13 during this life stage.

14 Lean protein like pork is important for

15 older adults, as higher protein diets help prevent

16 sarcopenia and declines in muscle mass and bone

17 density, thereby helping to prevent functional

18 decline and reducing the magnitude of associated

19 consequences like frailty and falls.

20 Regarding overall dietary patterns, the

21 2015 Dietary Guidelines emphasized that these are

22 adaptable and can be tailored to individual


185

1 preferences to make them more attainable,

2 enjoyable, and culturally appropriate.

3 Research has shown that the DASH and

4 Mediterranean diets, for example, can be expanded

5 to include lean pork for the same positive health

6 outcomes. We would also like to highlight recent

7 research that suggest saturated fats are not

8 associated with outcomes such as cardiovascular

9 disease as we had previously believed.

10 Given this context, a nutritionally

11 balanced diet can include foods that contain

12 saturated fats, but are nutritious overall.

13 Furthermore, lean, nutrient-rich animal protein

14 such as pork can help fulfill nutrient needs, while

15 limiting the amount of calories eaten.

16 A three-ounce serving of pork is an

17 excellent source of thiamin, selenium, protein,

18 niacin, vitamin B6 and phosphorus, and a food source

19 of riboflavin, zinc, and potassium. Pork also

20 provides several important nutrients identified by

21 the 2015 Guidelines between iron, potassium and

22 vitamin B12.


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1 Thank you for your time, your work and

2 we will provide written comments as well.


4 commenter 15.

5 DR. CLINTHORNE: Good afternoon. My

6 name is Dr. Jonathan Clinthorne, and I’m here on

7 behalf of Atkins Nutritionals. Today I want to

8 discuss two major points. The first is that while

9 it has been stated that the 2020 Dietary Guidelines

10 are intended for the general population, the

11 general population is not healthy.

12 Seventy-two percent of American adults

13 are overweight or obese. Fifty-two percent have

14 prediabetes or diabetes. Therefore, by excluding

15 studies from your systematic reviews that enroll

16 participants in a treatment diet, you are

17 effectively not producing guidelines for the

18 general population, something suggested by the

19 National Academies’ report.

20 Ultimately, that’s well over 100

21 million who are not receiving relevant eating

22 guidance. It’s also important to recognize that,


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1 despite the fact that the Guidelines are intended

2 for the general healthy population, they’re most

3 definitely influencing nutritional

4 recommendations for people who are not considered

5 healthy.

6 Let me give some examples. The

7 Guidelines inform the school lunch programs.

8 Current data indicates that one in five school-aged

9 children has obesity, while about 20 percent of

10 adolescents are estimated to have prediabetes.

11 They also inform nutrition

12 recommendations for the Department of Veterans

13 Affairs in their feeding programs for the elderly.

14 And yet the prevalence of type 2 diabetes is higher

15 in veterans than it is in the general population,

16 and nearly one in three are considered obese.

17 Meanwhile, one in four elderly people

18 are estimated to have type 2 diabetes and 48% of

19 people 65 and older have prediabetes. The

20 Guidelines also clear inform the nutrition policy

21 for many medical associations and hospitals, and if

22 these health care providers are not guiding people


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1 who have diet-related chronic diseases, then who

2 is?

3 The Guidelines are clearly being used to

4 provide nutritional recommendations for many

5 people with diet-related chronic diseases, so why

6 not make sure that these guidelines are based on

7 pertinent science?

8 My second point is that during your

9 assessment with dietary patterns, you must

10 accurately define low-carbohydrates diets in order

11 to properly account for this body of research.

12 The USDA has stated that you are

13 considering including studies where less than 45

14 percent of energy coming from carbohydrates is

15 qualifying as a low-carbohydrate diet, because this

16 is outside of the AMDR.

17 I am here to tell you that this is an

18 inaccurate characterization of low-carbohydrate

19 diets. We encourage the USDA to define

20 low-carbohydrate diets as containing less than 25

21 percent of energy from carbohydrate, or 133 grams

22 of carbohydrates per day.


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1 This recommendation would be consistent

2 with the adequate intake of 130 grams of

3 carbohydrates per day set by the National

4 Academies. In conclusion, I strongly encourage

5 the Advisory Committee to focus on the good of all

6 Americans and accurately define low-carbohydrate

7 diets.

8 Thank you.


10 commenter number 16.

11 DR. PALMER: My name is Chris Palmer.

12 I’m a physician and researcher at Harvard Medical

13 School. As we all know, we now have epidemics of

14 obesity and diabetes in this country.

15 Most people assume these problems are

16 fairly straightforward. They are, after all,

17 lifestyle diseases. They revolve around choices,

18 what people eat and, whether they exercise, simple

19 explanations with simple solutions. Eat less,

20 exercise more.

21 I’m here to tell you that it is not so

22 simple. You see, back 25 years ago, when I was a


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1 young physician, I was following the Dietary

2 Guidelines to a T, eating the recommended diet and

3 exercising regularly.

4 I was meticulous about it, because I

5 wanted to avoid the fate that I saw in the hospital

6 every day, and yet the Guidelines didn’t work for

7 me. I had high blood pressure and high

8 cholesterol, even though I was only in my 20s.

9 After years of the guidelines not

10 working, I was told that I had to go on medication.

11 In a last-ditch act of defiance, I changed my diet

12 to a low-carbohydrate diet.

13 Lo and behold, after three months, all

14 of my cardiac risk profile improved dramatically.

15 I have never looked back and I’ve remained healthy,

16 off medications, for 23 years now on this diet.

17 As a physician, I want to understand

18 what happened. Why did the Guidelines fail me, and

19 what can we do about it going forward? One clear

20 problem with past Guidelines is that they weren’t

21 based on the best science.

22 They were based on correlational


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1 studies, not randomized controlled trials.

2 Everyone knows that correlation doesn’t equal

3 causation. I wish the past Guidelines Committee

4 knew that.

5 We also know that when diets leave

6 people feeling hungry, they are destined to fail.

7 If people often feel hungry, maintaining a normal

8 weight is next to impossible.

9 We now have science showing that hunger

10 is driven by many hormones and their effects on the

11 brain. One of these is insulin. When a brain is

12 insulin-resistant, it is hungry.

13 So what can we do about this? One

14 solution already proven to work is eating a

15 low-carbohydrate diet. You see, the science now

16 explains why this diet has worked so well for me,

17 but it is not just me.

18 As a physician, I’ve seen this work in

19 countless patients. I have a patient right now

20 who’s lost over 150 pounds and has kept it off for

21 over four years. He’s still going strong. And by

22 the way, he also has schizophrenia.


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1 Most people see him as profoundly ill

2 and unmotivated, yet he did this and is still doing

3 it, because it works. With accurate and effective

4 advice, even he can maintain a healthy weight now,

5 and his cardiac risk profile improved dramatically

6 too.

7 I ask you to prioritize the science and

8 include a low-carbohydrate diet as at least one

9 option in the new Guidelines. The American

10 Diabetes Association has done this and so should

11 you.

12 Hundreds of millions of people are

13 counting on all of you to get this right.


15 Commenter number 17?

16 MR. TUMA: I’m Pepin Tuma with the

17 Academy of Nutrition Dietetics, representing more

18 than 107,000 registered dietitian nutritionists

19 and other nutrition professionals. There are two

20 related themes we’d like to underscore this

21 afternoon.

22 First, the scientific report needs to


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1 provide clear, relevant dietary guidance

2 appropriate for distinct subpopulations. And

3 second, it’s critical to draft the scientific

4 report bearing in mind the immense real impact for

5 work you’re doing, specifically the fact that the

6 guidelines will dictate vast amounts of food

7 policy, nutrition education, and consumption

8 patterns in the United States.

9 First, we applaud the shift to a life

10 stages approach as an important step in ensuring the

11 Dietary Guidelines are both relevant and accurate.

12 These Guidelines will be the first to include

13 nutrition guidance tailored for infants and young

14 children, and we hope they will provide relevant

15 guidance for the elderly, the 133 million Americans

16 with one or more chronic health conditions, and for

17 individuals with various cultural backgrounds.

18 As DGAC members said yesterday, we must

19 meet people where they are, recognizing the role

20 that socioeconomic status, health, food

21 insecurity, and life stage plays in determining how

22 to help Americans meet their diverse dietary needs.


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1 Second, it’s important to assess how the

2 recommendations in your scientific report and the

3 final Guidelines currently are and will be

4 translated into practice.

5 In the past two months alone, the GAO

6 published a report looking at nutrition assistance

7 programs intended to meet the needs of older adults.

8 And USDA proposed yet another change to the child

9 nutrition programs standards, likely to limit

10 access to an adequate amount and variety of fruits

11 and vegetables.

12 Whether it’s the Child and Adult Care

13 Food Program, congregate or home-delivered meal

14 programs, National School Lunch Program or the

15 School Breakfast Program, the Dietary Guidelines

16 form the basis for these underlying nutrition

17 requirements, and it is appropriate and indeed

18 necessary to ascertain whether these programs are

19 successfully meeting the requirements.

20 Many children consume two-thirds of

21 their meals at school. Are these meals ensuring

22 children meet two-thirds of their dietary needs in


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1 every way, in a healthy way? Are they helping to

2 establish healthy eating behaviors, or are we

3 moving backwards again?

4 The GAO report states that HHS plans to

5 focus on older adults in a future update to the

6 Guidelines, but has not documented a plan for doing

7 so, and it recommends documenting such a plan to

8 help ensure Guidelines better address the needs of

9 the population.

10 We respectfully encourage your

11 Committee to identify opportunities to address

12 these issues now, enabling a more robust plan to be

13 developed and solidified in advance of the

14 2025-2030 Guidelines.

15 So whether you’re tasked with

16 implementing government food and nutrition

17 programs, or you’re simply just a single American

18 trying to eat right, it can be challenging to meet

19 these recommendations.

20 But the solution is not to change them

21 or throw up our hands and tacitly not agree with

22 them. The scientific report can provide clarity,


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1 acting as a compass for the direction, development

2 and implementation of the federal program’s

3 nutrition standards.

4 When there are challenges identified in

5 meeting food patterns, acknowledge them in advance

6 and couple guidelines with known strategies to help

7 facilitate behavior change, like nutrition

8 education, that will help facilitate full adoption

9 of the DGAs in different food environments.

10 Thank you very much.



13 DR. CARNEY: I’m Linda Carney, MD from

14 DrCarney.com. I’m a physician practices lifestyle

15 medicine on children and adults near Austin, Texas,

16 and I’m double-board-certified by ADEM and the

17 American Board of Lifestyle Medicine.

18 In my private practice, I enjoy helping

19 my patients recover from many diseases when they

20 completely stop eating animal products.

21 Overwhelming amounts of scientific evidence show

22 that the best diet is an oil-free, low-fat,


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1 plant-based diet of whole, unprocessed foods which

2 powerfully reverses disease.

3 When my patients avoid eggs, dairy,

4 seafood, and other meats, they reverse multiple

5 sclerosis, diabetes too, high blood pressure, heart

6 disease, and asthma, which I myself reversed when

7 I began eating an oil-free vegan diet.

8 Complex carbohydrates like quinoa and

9 beans are foods to promote, not to mislabel as bad

10 carbs like sugar and white flour. In our new

11 Dietary Guidelines, animal products should be

12 completely replaced by vegetables, beans, fruit and

13 whole unprocessed grains.

14 The excellent scientific research in

15 Adventist Health Study 2 clearly shows how

16 destructive animal foods are with the less animal

17 products eaten, the less diabetes, cancer, stroke

18 and heart attacks.

19 As you teach America what a healthy diet

20 is for each age, after weaning off breast milk, note

21 that the Academy of Nutrition and Dietetics writes

22 that low-fat vegan diets are healthy for every age.


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1 I served as medical director for the

2 employees of Whole Foods Market, who came through

3 Rip Esselstyn’s Engine Two Immersion, proving to

4 corporate American that they could save money on

5 health care costs.

6 After just one week of eating an

7 oil-free, plant-based diet without meat, dairy or

8 eggs, my staff measured the Whole Foods Market

9 employees at the beginning of the week and at the

10 end of the week, and we saw cholesterols come down

11 a hundred points in just five days.

12 I was able to get many of them off blood

13 pressure medicine and safely off insulin by some of

14 them by the end of the week with normal blood sugars

15 and weight loss, despite eating all that they wanted

16 and loving the food.

17 Please formulate guidelines that admit

18 how truly disease-producing it is to eat beef, even

19 when it’s lean and grass-fed, or eggs, even if

20 they’re oil-free -- cage-free and organic, and how

21 dangerous dairy is, even if it’s low-fat, and how

22 fish promotes cancer and diabetes.


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1 The USDA suffers a clear conflict of

2 interest by promoting dairy and meats as healthy to

3 eat, despite all the scientific evidence to the

4 contrary. Please let us stop forcing the children

5 in day care to drink cow milk to get federal

6 subsidies, because we know that 70 percent of the

7 world’s children suffer when they’re damaged by

8 dairy.

9 Unless USDA takes a clear stance against

10 animal products, Americans will get sicker and

11 sicker, despite our spending more per capita of our

12 gross domestic product on health care.

13 Save America. Save our health, USDA.

14 Please ditch dairy. Mooooove meat off the menu.

15 MS. BROWN: Thank you. Next we’ll have


17 DR. FRANTZEN: Good afternoon. I’m

18 Lana Frantzen, and I proudly represent our dairy

19 farmers of America, and I have done so for the last

20 20 years. I feel very passionately about working

21 for dairy farmers and with Dairy MAX, our regional

22 dairy council.


200

1 I want to start with the most important

2 point that I want to share with you all today, and

3 that is, dairy is essential in life. We know that

4 when we look at the nutrient package that dairy

5 delivers, it’s -- there is no other.

6 When I think about the current Dietary

7 Guidelines, we look at the fact that real cow’s milk

8 is in over 94 percent of all American homes, and we

9 also note that the goal moving forward is to connect

10 the benefits with all cultures and help people

11 understand the unique nutrition that dairy

12 delivers.

13 I have my PhD in nutrition. I have 25

14 years of experience in nutrition education. I was

15 raised in San Antonio, Texas, not far from here

16 where, unfortunately, type 2 diabetes is prevalence

17 within our Hispanic community.

18 We need to all work together to ensure

19 that the Guidelines are reaching those who need them

20 most. Cardiovascular disease and type 2 diabetes

21 is prevalent in our U.S. population. African

22 Americans and Hispanic Americans may be at an even


201

1 higher risk.

2 Dairy is essential for three reasons.

3 First, the intake of dairy foods is associated with

4 the reduced risk of cardiovascular disease, type 2

5 diabetes, and lower blood pressure in adults.

6 With a focus on health disparities, the

7 National Medical Association and the National

8 Hispanic Medical Association support three

9 servings of dairy a day as a way to decrease the

10 nutrient intake shortfall.

11 When we look at milk, cheese, and

12 yogurt, they deliver a variety of nutrients,

13 specifically three of the nutrients of public

14 health concern. Three servings of dairy will

15 deliver up to 70 percent of the vitamin D and

16 calcium, and 30 percent of the potassium in our

17 diet.

18 And lastly, we know there’s decades of

19 science to support the health benefits of dairy.

20 There was a study published this week in Nutrients

21 that illustrates a simple, realistic dietary change

22 at the population level consisting of the


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1 recommended three servings of dairy a day could

2 result in over $12 billion in health care cost

3 savings.

4 Despite those benefits, I know there is

5 a lot of misinformation on lactose intolerance. My

6 father and my brother are both lactose intolerant.

7 Let’s be clear that if lactose intolerance is

8 confirmed, that health care providers --


10 DR. FRANTZEN: -- can support -- thank

11 you.

12 MS. BROWN: We’ll now have commenter

13 number 20. Okay. Can we move to commenter number

14 21?

15 DR. DODDS: Good afternoon. My name is

16 Dr. Michael Dodds, and I’m whole health lead

17 scientist at Mars Wrigley, and an adjunct professor

18 at UIC College of Dentistry in Chicago.

19 On behalf of Mars Wrigley, I provided

20 oral comments to the Dietary Guidelines Advisory

21 Committee at the July meeting. I thank USDA and HHS

22 for the opportunity today to provide highlights of


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1 new research on the effectiveness of chewing

2 sugar-free gum as a preventive oral health practice

3 to protect teeth, important to intake of fruits,

4 vegetables, whole grains, and other healthy foods.

5 This research is germane to the protocol

6 for the evidence review that the subcommittee on

7 Data Analysis and Food Pattern Modeling

8 cross-cutting working group will conduct to

9 describe and evaluate current prevalence of

10 nutrition-related chronic health outcomes,

11 including dentition.

12 The 2005-2010 Dietary Guidelines

13 recognized the importance of oral health prevention

14 by recommending brushing, flossing, and drinking

15 fluoridated water, but the 2015 version did not.

16 The evidence I will present today

17 supports adding sugar-free gum for 20 minutes after

18 snacks or meals to this list. Dental caries is one

19 of the most common of all chronic conditions in the

20 United States.

21 NCHS estimates that nearly nine percent

22 of children two to four years of age and over 25


204

1 percent of adults suffer from untreated decay.

2 Fluoridation of water supplies and improvements of

3 lifestyles have helped reduce caries prevalence,

4 but national rates of tooth decay continues to

5 present a major public health concern.

6 Tooth loss has been associated with loss

7 of ability to consume fibrous, nutrient-dense

8 foods, and impaired social functioning.

9 Therefore, dental diseases have a detrimental

10 effect on quality of life, health and well-being in

11 both childhood and older age.

12 A new systematic review has found

13 evidence reinforcing effectiveness of sugar-free

14 gum in helping to improve oral health. This

15 research was independently carried out by the

16 faculty of dentistry at King’s College London with

17 financial support from the Wrigley Oral Health Care

18 Program.

19 It examined differences in levels of

20 caries in adults and children who chew sugar-free

21 gum compared with non-chewing controls. Results

22 found that chewing sugar-free gum significantly


205

1 reduced caries incidence, giving a preventive

2 fraction of 28 percent, compared to 24 percent

3 preventive fraction for fluoride toothpastes and

4 fluoride supplements.

5 This research is the most robust

6 systematic review conducted to date into the

7 effectiveness of sugar-free gum in reducing caries

8 incidence. Results reinforce the growing body of

9 evidence highlighting an important role for chewing

10 sugar-free gum in improving oral health, especially

11 for the growing number of people who snack

12 frequently.

13 As the subcommittee begins its review of

14 the health outcomes, we request inclusion of the

15 research articles analyzing this meta-analysis.

16 Oral health preventive practices have significant

17 dietary benefits for all Americans by updating

18 Dietary Guidelines to reflect how changing eating

19 behaviors is having a renewed emphasis on

20 preventive measures such as brushing, flossing, and

21 the use of sugar-free gum after snacks and meals.

22 USDA can create the basic guidance for


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1 nutrition and dental professionals, along with

2 community practitioners, for the population with

3 alarmingly high dental problems. I thank you for

4 the opportunity to provide these comments.

5 MS. BROWN: We’ll now have commenter

6 number 22.

7 DR. ERIKSEN: Good afternoon. I’m Dr.

8 Nancy Ericksen. I’m representing myself. First,

9 thank you for allowing me to make comments this

10 afternoon and thank you for your hard work.

11 As a maternal-fetal medicine doctor, I

12 continue to see the rate of obesity and other

13 chronic diseases escalate among pregnant women

14 every year, leading to ever-increasing adverse

15 maternal outcomes, pregnancy outcomes, including

16 maternal death.

17 The maternal mortality rate in the

18 United States is currently the highest of all the

19 developed nations, with many of causes of death

20 directly or indirectly the result of obesity,

21 hypertension and cardiovascular disease.

22 In other words, they are all potentially


207

1 preventable causes of death. As you know, the

2 United States is currently in a health care crisis,

3 with seven out of the 10 leading causes of death

4 attributed to lifestyle, leading to skyrocketing

5 and unsustainable health care costs.

6 The number one killer of Americans,

7 heart disease, has already been shown to be

8 reversible by a high-fiber, whole food, plant-based

9 diet, consisting of more than 60 grams of fiber per

10 day.

11 This same high-fiber diet has also been

12 shown to substantially reduce the risk of obesity,

13 diabetes, hypertension, stroke and cardiovascular

14 disease, and recently there’s been two

15 meta-analyses that show there’s a dose response to

16 fiber.

17 One of which was published two years ago

18 shows that consumption of 50 grams or more of daily

19 dietary fiber can reduce your risk of colon cancer

20 by 50 percent.

21 The other shows that for women consuming

22 15 grams or more per day can increase their


208

1 risk -- or lower their risk for

2 estrogen-receptor-positive breast cancer by 15

3 percent.

4 In other words, if they consume more

5 than 60 grams per day, they can reduce that risk by

6 60 percent. And this same diet has also been shown

7 to reverse diseases like obesity, diabetes,

8 cardiovascular disease and others.

9 Yet currently the Dietary Guidelines

10 only recommend 25 grams per day of fiber for women,

11 and 30-34 grams per day for men, only half of what

12 is really required to make a substantial impact on

13 reducing disease and reversing disease.

14 And as we know, it’s not just the

15 calories or the micronutrients or the

16 macronutrients. It’s how those calories are

17 packaged. High-fiber diets have been shown

18 repeatedly to both prevent and reverse disease.

19 And quite frankly, I became

20 board-certified in lifestyle medicine recently

21 because I want to send a message to patients that

22 a high-fiber diet is really optimal for their


209

1 health, but they’re confused.

2 So I’m appealing to you as the Dietary

3 Guidelines in the next season to increase the

4 requirement for daily dietary fiber to a level at

5 which we can actually prevent and reverse disease.

6 This esteemed Committee is at an

7 historic crossroads today. Each of you has the

8 ability to advance the health care of all Americans

9 by simply stating in the Guidelines, we recommend

10 a high-fiber diet for all Americans.


12 Commenter number 23.

13 DR. GOLDNER: Hello. My name is Dr.

14 Brooke Goldner, and I’m a board-certified

15 physician, and I specialize in disease reversal

16 using nutrition. Now, before I became a doctor, I

17 actually was a patient.

18 I was diagnosed at 16 years old with

19 lupus. I had stage four kidney failure. I had

20 blood clots that caused mini-strokes. I endured

21 years of chemotherapy and steroids just to survive.

22 Now, all I ever learned never helped me


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1 with my health. It was always about survival. I

2 did three years of genetic research at Carnegie

3 Mellon. I went to medical school. I was chief

4 resident.

5 And yet I still needed medicine to

6 survive. Twelve years, I was sick. And then 15

7 years ago, I changed my diet to a plant-based diet

8 and got rid of dairy, no animal products, and within

9 three months, the lupus was gone.

10 I have been healthy for 15 years with no

11 sign of disease. I’ve had children, and I’ve

12 dedicated my life to this, and over the past decade,

13 I have helped thousands of people reverse lupus,

14 rheumatoid arthritis, multiple sclerosis,

15 diabetes, heart disease, number-one killer, all by

16 getting them to stop eating meat and dairy and eggs

17 and focus on vegetables and high-nutrient plant

18 foods, and the results are consistent and they are

19 profound.

20 As a doctor, my colleagues can attest to

21 the fact that we are chasing down an epidemic of

22 disease that we cannot hope to catch up to or


211

1 overtake, because people are getting sicker with

2 every meal they eat.

3 But you can make that difference.

4 Because people don’t know who to trust, but if the

5 Dietary Guidelines say that people should be

6 focusing on a plant-based diet full of vegetables

7 and fruits, and they should be limiting or

8 eliminating meat and dairy, eggs, they will have at

9 least the right information to start making better

10 decisions.

11 And so both as a doctor that is

12 desperately trying to save lives, and as a former

13 patient who has almost died many times because I

14 didn’t have this information, I beseech you to take

15 this seriously.

16 This decision about what’s recommended

17 to the public about what they eat should not be based

18 off of what’s good for industry. It should be based

19 on what’s good for human health, and there are

20 people who are suffering and dying right now from

21 the lack of this information.

22 So I ask you to take that seriously.


212

1 The literature is clear, and the results we see are

2 true. When you eliminate meat, dairy, and eggs,

3 people’s health gets better, so please recommend a

4 plant-based diet. Encourage people to limit or

5 eliminate animal foods, so that you can save lives.

6 Please help me with this mission. I

7 appreciate your time. Thank you for your

8 attention.


10 We’ll now have commenter number 24.

11 DR. HEANER: Hi. My name is Dr.

12 Martica Heaner, and I am a nutrition professor at

13 Hunter College, part of the City University of New

14 York, and I’ve also been a research scientist

15 studying obesity at Columbia University.

16 Last year, Canada released their

17 Dietary Guidelines and took bold steps

18 de-emphasizing the role of dairy. Currently, the

19 USDA not only recommends low-fat dairy, dairy is

20 granted special status as one of our five major food

21 groups.

22 Dairy should not be granted special


213

1 status. At best, it should be a sometime food, like

2 sugar-sweetened beverages. Dairy foods from

3 animals are problematic for a variety of reasons for

4 a majority of the population.

5 Milk is the perfect biological compound

6 for baby cows, but milk is not designed for humans.

7 If the Committee advises that humans -- adult

8 humans, especially, should consume milk,

9 logically, they should recommend breast milk from

10 humans, not from cows or animals.

11 Milk does contain nutrients: fats,

12 carbohydrates, protein and micronutrients. The

13 Guidelines have addressed the problems with

14 saturated fat by recommending low-fat dairy.

15 However, problems that people experience with the

16 other two macros have not been addressed

17 sufficiently.

18 An estimated 50 million Americans are

19 lactose-intolerant, including up to 90 percent of

20 Hispanics, African Americans and Asians. In

21 addition, an estimated 10 percent or so of people

22 have allergies to milk proteins or other compounds


214

1 in the milk products.

2 This prevalence may be higher because

3 many people do not realize that many of their health

4 symptoms or conditions like acne, migraines, pain

5 from arthritis, allergies, asthma can be caused by

6 or exacerbated by the dairy they consume daily.

7 I used to eat dairy every day and loved

8 it. I didn’t realize it was causing my asthma. I

9 was on two inhalers a day. My doctor told me it was

10 my one cat. It was only when I had an anaphylactic

11 reaction and truly nearly died -- I couldn’t

12 breathe -- to one sip of milk, that I realized how

13 toxic dairy is.

14 I gave up dairy, and my asthma

15 disappeared. I have not used inhalers in seven

16 years. I now have five cats, no asthma. There is

17 no denying that dairy contains nutrients.

18 It is a healthy food for cows, after all.

19 It’s high in protein and calcium. If you look at

20 the research, though, you’ll find that hay is also

21 high in protein and calcium. However, just as with

22 dairy, humans have a hard time digesting hay.


215

1 I urge the Committee to remove dairy as

2 its own food group, and to de-emphasize it as a

3 dietary recommendation. There are great profits

4 to be made from dairy, and I understand we have

5 concern for the farmers, but with new technology,

6 all industries evolve, and many dairy farmers are

7 starting to produce plant milks, plant cheeses --


9 DR. HEANER: -- and growing vegetables.


11 We’ll next have commenter number 25.

12 MR. MARTINEZ: Good afternoon. My

13 name is Tony Martinez, and I’m from Ossining, New

14 York. I’m an attorney. I am a type 2 diabetes and

15 heart disease patient in remission through a

16 ketogenic carnivorous diet, and I’m also a

17 candidate for the New York State Senate in my

18 district, because I’m very concerned on these

19 issues.

20 I had a heart attack on March 29, 2014,

21 and I have recovered through diet alone. I’m

22 basically on a ketogenic carnivorous diet for five


216

1 and a half years, and I now have saved over $24,000

2 in prescription drugs that I otherwise would have

3 required had I not put my condition into remission.

4 I understand that people here have very

5 strong feelings about what people should be eating

6 and so forth. The point is I have to say -- is we

7 have to have options, particularly a low-carb

8 option, and the fact that this needs to should be

9 recognized.

10 Low-carb means 25 percent of calories,

11 not 45, with the all due respect. And -- because

12 that’s basically -- I keep my calories to about 20

13 percent carbohydrate.

14 And these guidelines that you’re going

15 to be putting together have to take into account

16 options that the majority of this country is not

17 healthy, metabolically healthy.

18 So we need to have options, and to give

19 you one -- to give you some input on how impactful

20 this is in my state, right now, diabetes costs the

21 state of New York on Medicaid dollars alone over

22 $1.5 billion.


217

1 That’s for the neediest group of

2 community in our state, people who really need

3 health care. And the budget, the Medicaid budget,

4 right now is in a deficit of $6 million. And our

5 Governor, Governor Cuomo, has announced in his

6 budget statement, he’s going to cut $2-1/2 billion

7 across the board if the legislature doesn’t do one

8 of both of two things, raise taxes or cut services

9 on their own, and nobody likes that, and nobody

10 needs to be in that position.

11 We need some flexibility. So the fact

12 that I’ve been able to save over $24,000 in

13 prescription drug costs, just by following a

14 ketogenic carnivorous diet, which works for me.

15 And just for the record, if I can

16 clarify, the most nutrient-dense food are

17 animal-based; they’re not plant-based. So we need

18 options, and we need to temper our passions about

19 imposing our views on everybody.

20 We just need options. So I ask the

21 Committee for that consideration. Thank you.

22 MS. BROWN: Thank you. We’ll next have


218


2 DR. WALLACE: Good afternoon. My name

3 is Dr. Taylor Wallace, and I’m providing comment on

4 behalf of myself as principal at Think Healthy

5 Group, and an affiliate professor at Department of

6 Nutrition and Food Studies at George Mason

7 University, as well as a decade-long researcher in

8 the area of flavonoids.

9 My travel here today was provided by

10 Unilever; however, I did not accept honoraria for

11 financial incentive for these comments, which are

12 mine alone.

13 Research on flavonoids and other

14 bioactives have exploded over the past decade.

15 Our lab alone published numerous peer review

16 manuscripts highlighting the role of various

17 flavonoids subclasses in the prevention of

18 cardiovascular disease, the number-one killer of

19 Americans.

20 We further highlight the role that

21 flavonoids play in improving blood lipids, lipid

22 oxidation, flow-mediated dilation and blood


219

1 pressure.

2 Evidence also shows that dietary intake

3 of flavonoids may help modulate multiple cytokines,

4 chemokines and inflammatory factors such as

5 NF-kappa B, in addition to promoting flow-mediated

6 dilation by enhancing the synthesis of endothelial

7 nitric oxide.

8 Certainly, higher intakes of fruits and

9 vegetables help to promote health and protect us

10 from disease incidence, but these effects are

11 solely due to their essential nutrient contents,

12 but also their bioactive contents.

13 In particular, tea drinkers have been

14 shown to have up to 20 times the flavonoid intake

15 of non-tea consumers. Using the National

16 Academies’ standards, our group recently published

17 a systematic review of nearly 40 prospective cohort

18 studies on tea flavonoid consumption and

19 cardiovascular disease events and mortality.

20 We found linear dose response

21 relationships of tea intake on all-cause mortality,

22 cardiovascular morality, cardiovascular events,


220

1 and stroke events. Two other fairly recent

2 systematic reviews, including one which assessed

3 the effects of tea flavonoids on flow-mediated

4 dilation, as well as a Cochrane Review, assessing

5 the effects of tea flavonoids on blood pressure and

6 blood lipids, provide mechanistic insight into our

7 findings on cardiovascular events and outcomes.

8 No adverse effects of flavonoid intake

9 were noted among the hundreds of studies included

10 in these systematic reviews. For once, the

11 epidemiology and clinical trial data are

12 consistent, and it’s time that nutrition policy

13 reflects these findings.

14 We must begin to give guidance to

15 Americans around the consumption of dietary

16 bioactive compounds, such as flavonoids. And

17 finally, to the Committee, on behalf of myself and

18 everyone else here from Washington, D.C. today,

19 thank you for giving us the opportunity to come and

20 comment somewhere nice and sunny.

21 Houston has been lovely.

22 MS. BROWN: Thank you. We do want to


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1 announce that we’ll do three more comments, and then

2 we’ll take a brief break, and so we’ll do three more,

3 beginning with number 27.

4 DR. CHAWLA: Good afternoon. My name

5 is Dr. Bandana Chawla. I’m also a physician, and

6 I’m happy to see so many other physicians here

7 because they’re passionate about the health of

8 their patients and their community.

9 I am triple board-certified in internal

10 medicine, hospice and palliative medicine, and now

11 the new evidence-based field of lifestyle medicine.

12 I’ve been practicing here in the Houston area for

13 over 20 years.

14 For the sake of my patients’ health and

15 the health of everyone in our American community,

16 I urge this Committee to inform the public and

17 explicitly state the hazards of processed meats in

18 the new Guidelines.

19 Processed meats, such as hot dogs,

20 bacon, pepperoni, sausage, and lunch meats, all

21 increase the risk of colorectal cancer,

22 cardiovascular disease, and even early death. The


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1 World Health Organization has determined that

2 processed meat is a major contributor to colorectal

3 cancer, classifying it as type one carcinogenic to

4 humans. Just one hot dog or a few strips of bacon

5 consumed daily increased cancer risk by 18 percent.

6 The World Cancer Research Fund and the

7 American Institute for American Cancer Research

8 have also found that the evidence on processed meat

9 and cancer is clear-cut.

10 Colorectal cancer isn’t the only cancer

11 risk that comes from consuming processed meat.

12 Eating 50 grams of processed meat daily also

13 increases the risk for prostate cancer, pancreatic

14 cancer, and overall cancer mortality.

15 And a study of more than 200,000 women

16 found that eating about 20 grams of processed meat

17 each day, less than half the size of a regular hot

18 dog, increased breast cancer risk by 21 percent.

19 Those who consume the most processed

20 meat also have an increased risk of death from

21 cardiovascular disease, according to a National

22 Institute of Health study of more than half a


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1 million people.

2 Experts from Harvard University

3 recommend that Dietary Guidelines exclude red and

4 processed meat in favor of plant-based foods for the

5 benefit of human health and the environment,

6 according to a publication from the American

7 Diabetes Association.

8 Researchers reassessed the health

9 impacts of these foods and found close associations

10 between red and processed meat consumption and

11 diabetes and increased mortality.

12 The evidence is clear, and the general

13 public needs this Committee to educate and empower

14 them. It is USDA’s obligation to encourage the

15 American people to eliminate processed meat from

16 their diet so they can reduce the risk of several

17 illnesses, and hence the suffering --


19 DR. CHAWLA: -- that results from them.

20 Thank you.

21 MS. BROWN: Next, we’ll have commenter

22 number 28.


224

1 DR. CHAWLA: Hi. I’m Dr. Munish

2 Chawla. I’m representing myself. I’m a

3 board-certified physician in radiology and

4 lifestyle medicine. Thank you very much for the

5 opportunity to speak here today.

6 The USDA Guidelines are not just

7 important for lay citizens but are important for the

8 National School Lunch Program, which helps guide

9 the nutritional adequacy of the meals that are

10 served at our schools.

11 With the current epidemic of chronic

12 diseases in our society such as diabetes, heart

13 disease, and obesity, and in particular, childhood

14 obesity, these Dietary Guidelines are more

15 important than ever.

16 The 2015-2020 Guidelines do a great job

17 of informing the public that it is important to

18 focus on a healthy eating pattern. As per the

19 current Guidelines, this healthy eating pattern

20 includes a variety of vegetables, fruits, whole

21 grain, low-fat dairy, and proteins, and

22 furthermore, it is specified that a healthy eating


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1 pattern limits saturated fat and sodium.

2 This statement should be applauded,

3 since we have clear evidence which shows saturated

4 fat increases our cholesterol, which is an

5 important risk factor for heart disease. The

6 largest contributor of saturated fat in the

7 American diet today is dairy.

8 So dairy should not be part of My Plate.

9 This should be replaced with water. This will not

10 only reduce saturated fat in the diet, but it will

11 decrease the overall calories in the meal, which is

12 crucial, given the current obesity epidemic.

13 Supporting figures in the current

14 Guidelines which use My Plate as a teaching tool

15 also indicate that we should decrease consumption

16 of saturated fats, sodium and added sugars.

17 It would be extremely helpful for

18 Americans if specific foods were mentioned, so it

19 is clear what foods should be avoided. A clear

20 statement which states, greatly reducing the

21 consumption of mixed dishes, such as burgers,

22 pizza, pasta with meat sauce, would greatly reduce


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1 the amount of saturated fat and sodium in the meal.

2 Other similar statements, such as

3 reducing consumption of cakes, pies, cookies, and

4 pastries, would greatly reduce the consumption of

5 saturated fat, refined grains, and sugar. I would

6 also urge that a more clear example of healthy

7 choices be given.

8 A well balanced meal such as tofu with

9 vegetables served with rice and a garden salad would

10 be far superior to the currently highlighted meal

11 of spaghetti with meatballs.

12 We have the research and all major

13 organizations, such as the American Heart

14 Association, World Health Organization and others,

15 agree that as a society, we need to reduce our

16 consumption of meat, dairy and eggs, and increase

17 our consumption of vegetables, fruits, and whole

18 grains.

19 Thank you for your time.

20 MS. BROWN: Thank you. We’ll next have

21 commenter number 29, which will be the last before

22 a 10-minute break.


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1 MS. EIGES: Good afternoon. My name is

2 Amy Eiges, and I’m here representing myself and

3 millions of people who have faithfully followed the

4 Guidelines, only to find themselves in poor health.

5 Year after year, diet after diet, I ate

6 according to the government’s recommendations to

7 lose weight but found it impossible to sustain. It

8 left me chronically hungry, morbidly obese, and

9 prediabetic.

10 Over and over, I was told that eating

11 everything in moderation, calories in, calories

12 out, following the Guidelines was the answer, and

13 it wasn’t working because I must be doing it wrong.

14 I needed more self-control and more

15 willpower, and it was all my fault. When my mother

16 died suddenly from congestive heart failure, a

17 direct result of type 2 diabetes, I woke up and

18 clearly saw my future.

19 Devastated by her death, I realized if

20 I didn’t try something different, I would suffer the

21 same fate. So a few years ago, imprisoned in a body

22 with a seemingly insurmountable 200 pounds to lose,


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1 I did some research, and discovered a very

2 low-carbohydrate ketogenic diet.

3 I started eating real whole foods,

4 protein, vegetables, dairy and fats to satiety. I

5 don’t eat when I’m not hungry. I don’t count

6 calories. It’s that simple. No gimmicks, no

7 fads, no special products.

8 To date, I have lost 173 pounds. I have

9 reversed prediabetes, and my cardiovascular health

10 is vastly improved. Triglycerides cut in half,

11 cholesterol great. I have successfully reclaimed

12 my health by not following the Guidelines, and I’m

13 far from alone in this.

14 Thousands of us are following a

15 low-carbohydrate plan after finding out we could

16 not depend on the harmful advice we were given. Our

17 trusted medical community, following the

18 Guidelines, has failed us.

19 It was not that we were fat, sick, and

20 lazy. We were fat, sick, and misinformed. If just

21 one of many "experts" I saw over the years had looked

22 at the rigorous science, I and countless others like


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1 me might not have been tortured for decades.

2 I might have had the life I was meant to

3 live. What so few are aware of is the Guidelines

4 are not for people who are metabolically unwell,

5 those with prediabetes, high blood pressure,

6 diabetes, obesity, heart disease, which altogether

7 is a staggering 88 percent of this country.

8 The Guidelines are only for the

9 remaining 12 percent whose bodies are metabolically

10 flexible enough to handle more than half of their

11 calories in carbohydrates and six servings of

12 grains a day.

13 But what about the rest of us? What are

14 you offering those of us who became sick and damaged

15 under your watch? A true and proper definition of

16 low carb is under 25 percent of calories. Anything

17 more, and the benefits are greatly reduced.

18 If this option had been available to

19 countless doctors over four decades of trying to get

20 healthy, they would have been able to offer me a

21 solution that actually works.

22 What most doctors won’t know is that


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1 this option is safe and effective unless you allow

2 it to be one of the approved dietary patterns.

3 Until then, their hands are tied and we all get

4 sicker with the one-size-fits-all option.

5 You have the power to finally, finally

6 end so much suffering by reversing course on the

7 health epidemics that are ravaging this nation.

8 Please land on the right side of history and be the

9 heroes our country so desperately needs, it’s long

10 overdue.

11 MS. BROWN: Thank you. Okay. We will

12 take a 10-minute break, so convene at 3:40 -- 2:40

13 Central Time. And we’ll talk with commenter number

14 30.

15 (A short recess was taken.)

16 MS. BROWN: We’ll ask everyone to begin

17 taking their seats. Please take your seats. Okay.

18 Thank you. Commenter number 30.

19 DR. SCHMIDT: Hi. My name is Dr.

20 Darren Schmidt. I spoke to you in July in D.C. I

21 focus on nutrition in my practice, my private

22 practice for 23 years at The Nutritional Healing


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1 Center of Ann Arbor.

2 My clinicians and I have seen 60,000

3 nutrition visits in the last five years. I want to

4 tell you about my patient Yael Rosner, a former Ms.

5 Israel, who had been struggling with her health.

6 She says to me, I must admit that I was

7 sure I was being healthy since I was following the

8 U.S. Food Pyramid. I became prediabetic, had

9 neuropathy in my feet, hypertension, overweight and

10 bloating.

11 When you had me switch to a low-carb

12 diet, I started to sleep better and longer, my feet

13 stopped hurting, my blood pressure dropped 20

14 points, and my blood glucose dropped 40. I’m

15 losing pounds and people are complimenting me and

16 I’m happier.

17 So I’m not surprised at this. I’ve had

18 thousands of patients over the years have great

19 results with the low-carb diet. Jeremy Martin had

20 spondylitis for 10 years. Painkillers ruined his

21 gut.

22 He took Cipro, which destroyed his


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1 tendons and nervous system. Years of eating

2 high-carb foods was his cause, and now with the

3 low-carb diet, he’s off all medications, pain-free,

4 down 60 pounds, and he’s smiling again.

5 These patients switched their diet to

6 the opposite of the current Dietary Guidelines.

7 Why is there such a discrepancy between the

8 Guidelines and these great results? Well, let me

9 explain it like this.

10 Do you remember the six steps of the

11 scientific method that we all learned in grade

12 school? Here they are. Step one, make an

13 observation. Step two, form a hypothesis. Step

14 three, test that hypothesis with an experiment to

15 see if it’s actually true or not. Four, analyze the

16 data. Then report the data. Then other

17 scientists have to replicate it.

18 Epidemiology is only the first two steps

19 out of six. It is certainly missing the

20 experiment. Therefore, it is an incomplete

21 scientific process. It is mostly just survey.

22 This includes the Blue Zones, Loma Linda,


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1 Seventh-Day Adventist, EPIC data, Okinawa, Eskimo,

2 and NHANES.

3 It is your charge by the law that you

4 have to use the preponderance of science. It takes

5 all six steps of the scientific method to qualify

6 as science, not just the first two steps, like an

7 epidemiological survey. The majority of your

8 studies you are using are incomplete regarding

9 scientific method.

10 Therefore, they are not science and need

11 to be discarded, per the jurisdiction of the law

12 that you’re operating. We need diversity in the

13 Guidelines. There is no one diet for all. The

14 low-carb diet has to be an option in your report,

15 just like the American Diabetes Association did.

16 There are 100 clinical trials,

17 experiments, actual science that proves the

18 low-carb diet is safe and effective. Please add at

19 least one line in your report that says a low-carb

20 diet of 25 percent or less of calories from

21 carbohydrates is a safe and viable option, because

22 it is.


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1 This is your opportunity to reverse 40

2 years of non-scientific guidelines, and it would be

3 two scientists to finally resolve our nation’s

4 health problems. And please don’t make me have to

5 come back in five years to repeat myself. Add the

6 low-carb option now. Thank you.


8 number 31.

9 MR. HAZARD: My name is Tyler Hazard,

10 and I’m providing testimony on behalf of Compassion

11 in World Farming USA, an international animal

12 protection and environmental organization.

13 According to the U.S. Department of

14 Agriculture and the Department of Health and Human

15 Services, the goal of the Dietary Guidelines is to

16 "promote health and reduce risk of chronic disease

17 for current and future generations."

18 I’m here today to emphasize it is

19 impossible to meet that objective without

20 dedicated, evidence-based consideration of the

21 environment impacts of our current food system.

22 There is global recognition that food


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1 choice has devastating consequences for our

2 environment, from greenhouse gas emissions to soil

3 degradation to water pollution.

4 There’s also global recognition that

5 the worst types of food for our delicate and

6 deteriorating ecosystems are in fact animal

7 products, chiefly dairy and meat, products that we

8 as Americans massively overconsume, in some cases

9 on levels three to four times the global average.

10 If we continue our over-reliance on

11 animal protein, agriculture alone will catapult us

12 past two degrees warming by 2050, at which point

13 scientists warn of catastrophic consequences

14 including, to this Committee’s prior concern,

15 within our food supply.

16 We know that an intensifying climate

17 with more frequent severe weather and distribution

18 channels inundated by sea level rise will see reduce

19 food yields, quality, safety, accessibility and

20 stability, creating a landscape of food insecurity

21 across the globe, the effects of which will

22 disproportionately impact women, children and


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1 elderly and be worse for lower-income families and

2 communities of color.

3 Further, that we know that alongside

4 increased rates of food insecurity, the climate

5 crisis will increase mental health and stress

6 disorders, infectious disease, and chronic

7 illness, risking the rapid deterioration of our

8 nation’s health, which stands in direct opposition

9 to your objective.

10 Due to this alarming reality, the United

11 Nations Intergovernmental Panel on Climate Change

12 has repeatedly called for a global reduction in

13 animal product consumptions, and in three separate

14 special reports in the last year alone, have called

15 for a transition towards plant-based diets,

16 specifically noting the national Dietary

17 Guidelines as a key opportunity to shift public

18 consumption.

19 From a health perspective, we ought to

20 already advise more plants and less meat, as

21 countless studies demonstrate the short- and

22 long-term benefits of plant-based diets on


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1 individual health, specifically in areas of

2 cardiovascular disease, type 2 diabetes,

3 colorectal cancer and all-cause mortality, the very

4 health issues we’ve been selected to study.

5 We are living in an unprecedented time

6 of climate emergency, where millions of

7 schoolchildren across the country flee their

8 classrooms and take to the streets to combat

9 government inaction, in fear where the planet will

10 leave them if we fail to address this issue, if we

11 fail to stave off our pending crisis, if we fail to

12 lead our kids with a regenerative food system that

13 enriches nature rather than depleting it. Make no

14 mistake: we are failing these children.

15 So I ask you to follow the precedent of

16 our forward-thinking allies at the United Nations

17 and countries like Canada and France, who have

18 recently adopted Dietary Guidelines that recognize

19 critical link between food consumption and human

20 health and long-term food security, and I ask you

21 to follow the precedent of your Advisory Committee

22 predecessors who in 2015 --


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2 MR. HAZARD: -- who had the courage and

3 foresight to acknowledge --


5 MR. HAZARD: -- that a rabid

6 consumption of animal products will inevitably --

7 MS. BROWN: Your time is up.

8 MR. HAZARD: -- push us past planetary

9 boundaries will be strained --

10 MS. BROWN: We will move to our next

11 commenter, commenter number 32.

12 DR. BRENNA: I’m Tom Brenna. I’m now

13 at the Dell Medical School, The University of Texas

14 at Austin, where I’m a professor of pediatrics, of

15 chemistry, and of nutrition. I’ll add my welcome

16 to Texas for all of you.

17 I’m presenting on behalf of myself and

18 a number of coauthors who I’ll mention in a moment.

19 Five years ago, I was in my last years of 28 years

20 on the active faculty at Cornell in the Nutrition

21 Department, and I was a member of the Dietary

22 Guidelines Committee.


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1 I found that oral comments meeting to be

2 most interesting, as I’m sure you are. My main

3 reason for being here is to bring your

4 attention -- bring to your attention a

5 peer-reviewed journal -- a peer-reviewed paper in

6 a journal, "Prostaglandins, Leukotrienes and

7 Essential Fatty Acids," that is intended to answer

8 the two seafood questions on the relationship of

9 seafood consumption in pregnancy or in childhood on

10 neurocognitive development.

11 Taking advantage of the new procedure

12 this year, early posting of questions, a group of

13 13 scientists including myself, senior scientists,

14 all academic researchers, I’ll note, with expertise

15 in psychiatry, child development, toxicology, and

16 all with an interest in nutrition, came together in

17 a grassroots effort, a grassroots voluntary effort,

18 and we can report no financial conflicts of

19 interest.

20 The NESR protocols are transparent and

21 enable anyone to replicate them. We faithfully

22 replicated -- or at least that was our intent, to


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1 faithfully replicate the NESR systematic review

2 process, with kind advice from the NESR staff before

3 we started.

4 Our results are on the DGAC comments

5 website, along with our comments and the papers were

6 posted, and they are open access. We did all the

7 work ourselves. We had no staff, no grad students,

8 no post-docs. We did it all ourselves. You know

9 how much work that would be.

10 You’ll see familiar information when

11 you look at the papers. You’ll see analytical

12 framework searches, evidence tables. Listening

13 yesterday, I was not surprised and gratified to say

14 that we’ve come to very similar conclusions with the

15 Seafood committee.

16 I think we can help each other. If you

17 look at our paper, you will see not only support for

18 the conclusions that were mentioned yesterday, but

19 you’ll also see including documenting moderate

20 evidence for benefit and moderate evidence for no

21 harm, and we support that designation.

22 Our paper also may be of value in


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1 evaluating dose response. We did convert units and

2 worked on that. So I thank you very much for your

3 attention and wish you luck in the work in front of

4 you.

5 MS. BROWN: Thank you. We’ll now move

6 to commenter number 33.

7 MS. JANUS: I’m Erin Janus,

8 representing myself.

9 Last year, in Canada, dairy was

10 officially removed from the food guide. After the

11 science was reviewed by leading health

12 professionals, it was concluded that dairy is

13 neither required nor recommended for a healthy and

14 balanced diet for any person at any age, but there’s

15 already an overwhelming number of physicians,

16 dietitians, nutritionists, and scientists who

17 we’ve heard from today that adamantly recommend

18 dairy be removed from the Dietary Guidelines.

19 So I’m not going to stand here and talk

20 about the many negative health consequences of

21 dairy. I’m here to bring up something else that

22 pertains to dairy that’s often grossly ignored and


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1 overlooked, and that is ethics.

2 The ethics of dairy has been undermined

3 by the dairy industry for decades, resulting in very

4 little knowledge about the animals who are used and

5 exploited to produce our beloved dairy products.

6 It’s because of this that the average

7 person is entirely oblivious to the standard

8 practices that make up dairy production. For

9 example, the average person does not know that all

10 dairy cows are repeatedly inseminated, year after

11 year, against their will, just to make them produce

12 milk.

13 The average person does not know that

14 every mother cow is separated from her baby calf

15 after just a few hours at birth in order to prevent

16 her baby from drinking her milk. And the average

17 person does not know that all mother dairy cows are

18 eventually sent to a slaughterhouse where they are

19 hung upside down and their throats are slashed open,

20 all while still alive.

21 By the way, for any of you who cast any

22 doubt, everything I just mentioned is standard


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1 practice, legal, certified humane, and commonplace

2 will all U.S. dairy operations, not just some.

3 So at what point will decision-makers

4 recognize that dairy cows are not commodities or

5 units of property, but rather they are highly

6 sensitive, intelligent, emotional beings who

7 deserve a life that is free from exploitation and

8 human violence?

9 When will it be recognized and accepted

10 that these unethical practices are completely

11 unnecessary to make healthy food choices in our

12 daily lives?

13 I hope that with all the current and

14 previous expert recommendations to remove dairy

15 consumption, advising against dairy consumption

16 and to remove it from the Guidelines, with Canada

17 being a prime example of how a civilized nation can

18 remove dairy from their Dietary Guidelines while

19 still providing healthy recommendations, that the

20 Advisory Committee will not only recognize that we

21 can be healthy without consuming dairy products,

22 but that it ought to be removed on the basis --


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1 MS. BROWN: Thank you for your comment.

2 MS. JANUS: -- of ethics? Thanks.

3 MS. BROWN: We’ll now move to number 34.

4 MS. JARDINE: Hello. My name is

5 Margaret Jardine. I am a dietitian and a diabetes

6 educator. I work at a large county hospital in

7 Dallas, Texas. I am here on behalf of myself.

8 Thank you for the opportunity to provide

9 my comments and expertise. When I first became a

10 dietitian 25 years ago, I rarely saw a person -- over

11 25 years ago, I rarely saw a person with class III

12 obesity. Now I see it daily.

13 I see younger and younger people with

14 type 2 diabetes on numerous medications, people who

15 should be in the prime of their lives and the peak

16 of their productivity.

17 The epidemics of obesity and diabetes

18 should be considered a national tragedy. I believe

19 this Committee should put the health of the American

20 people at the forefront of the Guidelines by

21 presenting evidence-based information about

22 disease prevention.


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1 The healthiest people on the plant

2 consume plant-based diets that are high in

3 unrefined carbohydrates from whole grains, legumes

4 or pulses, fruits, vegetables, nuts and seeds.

5 They eat very little animal products or processed

6 foods.

7 I have several recommendations I

8 believe the Committee should consider. First, be

9 specific about the foods to limit in order to reduce

10 disease.

11 Instead of recommending Americans limit

12 saturated fats, trans fats and sodium, the

13 Guidelines should recommending limiting or

14 eliminating red meat, processed meat, poultry and

15 cheese.

16 Second, the vegan option of the healthy

17 vegetarian eating pattern should be more prominent.

18 If you look at the Adventist Health Study 2, the

19 vegan group is the only group that had an ideal body

20 weight. They also had a significantly lower

21 incidence of type 2 diabetes when you compare it to

22 the vegetarian group.


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1 Third, be more up-front about the lack

2 of long-term evidence on low- carbohydrate diets.

3 Yes, I know these diets contribute to weight loss.

4 That does not mean they’re healthy. There are

5 numerous, large, peer-reviewed studies indicating

6 that people who limit grains, pulses, fruits and

7 starchy vegetables have early mortality. And

8 numerous studies linked animal products to obesity

9 and diabetes, as well as cardiovascular disease.

10 I think you would be hard pressed to find

11 a non-industry-funded study that demonstrates

12 animal products reduce disease. I have submitted

13 some articles of evidence supporting my statement

14 for your convenience.

15 Thank you so much for your time.


17 Next we’ll move to commenter number 35.

18 MS. WELLAND: My name is Diane Welland,

19 and I am the nutrition communications manager for

20 the Juice Products Association. JPA is a trade

21 association representing processors, growers,

22 packers, suppliers, and distributors to the juice


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1 industry.

2 We support the current Dietary

3 Guidelines for Americans stating that 100 percent

4 juice introduces beneficial nutrients to the diet

5 and, in appropriate amounts, can be included in a

6 healthy dietary pattern.

7 Several new studies confirm juice’s

8 positive role in the diet. They are in adults an

9 NHANES analysis study published in Nutrients in

10 October 2019, showed that 100 percent fruit juice

11 consumption is associated with a 10 percent higher

12 healthy eating index score than non-juice

13 consumption.

14 The higher HEI score was due to higher

15 intakes of whole fruit and total fruit and lower

16 intakes of added sugar, saturated fat and sodium.

17 Juice drinkers also had significantly higher

18 intakes of calcium, vitamin D, potassium, thiamin,

19 folate, vitamin B6 and vitamin C, with the first

20 three nutrients considered nutrients of concern by

21 the 2015 Dietary Guidelines.

22 Adults who consume 100 percent fruit


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1 juice have lower body mass index, lower body weight,

2 a 22 percent lower risk of being overweight or

3 obese, and a 27 percent lower risk of metabolic

4 syndrome, compared to non-consumers.

5 Similar results related to diet quality

6 and nutrient intake have been found in children.

7 An August 2019 study in Frontiers in Nutrition found

8 that, in children, high-quality diets had more

9 milk, more water, and more juice than lower-quality

10 diets.

11 There’s also no significant

12 relationship between 100 percent juice and body

13 weight status in children. In addition, a 2019

14 scientific review in Nutrition Reviews showed 100

15 percent juice adds a significant number of

16 bioactives to the American diet without negatively

17 impacting weight status or chronic disease risk.

18 Group bioactives include carotenoids,

19 polyphenols such as flavonoids, and more. The

20 review looked at polyphenols derived from fruit and

21 100 percent fruit juice. It showed it’s similar to

22 coffee and tea.


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1 Fruit and fruit juices have been

2 identified as major polyphenol contributors in the

3 diet. The data suggests bioactive found in fruit

4 and fruit juice may have the potential to positively

5 impact human health.

6 Some of the health benefits associated

7 with fruit polyphenols reported in the study

8 include reduced risk of cardiovascular disease,

9 which is also supported in the American Journal of

10 Clinical Nutrition, and benefits neurocognitive

11 function and exercise performance.

12 Given these new data, JPA recommends the

13 following: 100 percent juice should continue to be

14 part of the fruit and vegetable group and considered

15 a major beverage for consumption; the DGA should

16 acknowledge that, like fruits and vegetables, 100

17 percent fruits contains beneficial plant compounds

18 known as bioactives; it should be encouraged for

19 good health; and the final policy document should

20 recommend that Americans consume a diet containing

21 a variety of fruits rich in bioactives, and include

22 mention that fruits and vegetables and 100 percent


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1 juices are primary sources of bioactives.

2 Thank you.



5 DR. OTTO: Thank you for the

6 opportunity to present the views of the American

7 Heart Association. My name is Marcia Otto. I’m an

8 assistant professor at The University of Texas

9 School of Public Health and a member of the

10 nutrition committee.

11 The AHA is committed to helping people

12 achieve a healthy diet. Eating a healthy diet is

13 one of the best ways to fight heart disease, which

14 remains the number-one cause of death in the United

15 States.

16 To lower risk of heart disease, AHA

17 recommends a diet that emphasizes fruits,

18 vegetables, nuts, whole grains, lean protein and

19 fish, by minimizing the intakes of trans fats,

20 processed meats, refined carbohydrates and sugary

21 beverages.

22 AHA recommendations, just like the


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1 current Dietary Guidelines, focus on a healthy

2 dietary pattern, rather than a single nutrient,

3 ingredient or food. While admitting nutrient

4 needs is important, focusing on the overall dietary

5 pattern may help the consumers translate

6 recommendations into action when choosing what to

7 eat.

8 We encourage the Committee to keep the

9 focus on healthy eating patterns when it develops

10 its report. There are three elements of

11 heart-healthy dietary patterns that I’d like to

12 address today.

13 First, dietary fats. The Guidelines

14 should recommend replacing intake of saturated fat

15 with unsaturated fats, particularly

16 polyunsaturated fats, as such replacement is

17 associated with lower risk of heart disease.

18 Replacing saturated fats with

19 carbohydrates, however, especially refined

20 carbohydrates and sugars, does not lower heart

21 disease risk.

22 Second, the Committee should consider


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1 lowering the current recommendations for added

2 sugars. Many adults and children have very little

3 room in their diet for empty calories, and we need

4 to go lower than 10 percent in order to have a

5 healthy diet while meeting their essential nutrient

6 needs.

7 Added sugars intake is associated with

8 poor cardiovascular health in children at levels

9 far below current consumption in the United States.

10 Third, we understand that the Committee

11 is not examining sodium at this time, but the

12 Guidelines must incorporate the new dietary health

13 reference intake. The first is specific to chronic

14 disease risk reduction and include recommendations

15 to lower consumptions of key sources of sodium,

16 particularly processed foods.

17 Finally, we encourage the Committee to

18 consider how these recommendations can be

19 implemented. Policy- and population-based

20 solutions are also needed. Thank you.

21 MS. BROWN: Thank you. We understand

22 commenter number 37 cancelled, but we’ll pause to


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1 confirm.

2 (No response.)

3 MS. BROWN: And we’ll move to


5 MR. FRYE: Good afternoon. I’m Cary

6 Frye, senior vice president of regulatory affairs

7 at International Dairy Foods Association in

8 Washington, D.C. IDFA is a membership

9 organization that represents dairy cooperatives

10 and processors who make the nation’s milk and dairy

11 products.

12 Good nutrition is a foundation to health

13 and wellness for adults and children alike, and

14 dairy is a crucial part of a healthy diet. There

15 is no equal replacement for cow’s milk, which

16 provides nutrients including high-quality protein,

17 calcium, vitamin D and potassium, and offers health

18 benefits such as better bone health and lower risk

19 of type 2 diabetes and cardiovascular disease.

20 USDA and HHS continue to hold that

21 American children and adolescents over four years

22 old are not consuming the recommended amounts of


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1 dairy. Lactose-free and reduced lactose products

2 offer these nutritional benefits for consumers who

3 have sensitivities to lactose, and are accessible

4 today in any supermarket, making moot the arguments

5 that people who have sensitivities to lactose must

6 adopt a non-dairy diet.

7 Lactose-reduced milks account for 5

8 percent of milk sales, and virtually all cheeses are

9 lactose-free. Disappointingly, this Committee,

10 as well as American consumers, have been subject to

11 misleading claims about dairy products.

12 These false claims have confused and

13 scared the public, using weak studies based on

14 questionable scientific methods, and preyed on the

15 media’s preference for controversy.

16 Since the last DGAs, three things have

17 occurred that should cement dairy’s place in future

18 recommendations.

19 First, health organizations, including

20 the Academy of Nutrition and Dietetics, the

21 American Academy of Pediatrics, and the American

22 Heart Association, recommended children ages one to


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1 five consume just two beverages: cow’s milk and

2 water.

3 Second, dietary advice in other

4 countries have recommended full-fat dairy products

5 as part of healthy dietary patterns. Third,

6 several meta-analyses indicate that there is no

7 negative effect on heart healthy when consuming

8 dairy, no matter whether these dairy products are

9 full-fat or low-fat.

10 IDFA’s members have three requests for

11 the Committee. First, dairy should continue as a

12 separate group in the 2020 Dietary Guidelines for

13 Americans.

14 Second, the DGAs must preserve the

15 recommended three servings of dairy per day in

16 dietary patterns to ensure Americans meet their

17 recommended essential nutrient intakes.

18 And third, the Committee should embrace

19 the evidence showing dairy foods at all fat levels

20 are part of a nutritious diet. We appreciate the

21 opportunity to provide these oral comments and ask

22 the Committee to consider the science presented in


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1 our written comments.

2 Thank you.

3 MS. BROWN: Thank you. Commenter 39?

4 Do we have -- okay.

5 We will move then to commenter number

6 40.

7 MR. NGUYEN: Hello. I’m Minh Nguyen.

8 I’m a registered dietitian with the Physicians

9 Committee for Responsible Medicine, a nonprofit

10 nutrition advocacy organization.

11 I’m a native Houstonian. In fact, I did

12 my dietetic internship right here in the Texas

13 Medical Center across the street, at Texas Women’s

14 University. So I welcome y’all to my hometown, and

15 also thank you for listening to our comments today.

16 Today I’d like to discuss the risk of

17 low-carbohydrate diets, specifically diets that

18 decrease carbohydrates while increasing intake of

19 protein and fat. Despite incomplete and

20 conflicting data regarding their long-term effects

21 on health effects, people continue to adopt them

22 with misguided hopes.


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1 Low-carbohydrate diets are generally

2 used for quick weight loss, which is calorie

3 restriction at best, disease-promoting in reality.

4 Low-carbohydrate -- you know, all these types of

5 diets, it is also taught that cholesterol and

6 saturated fat consumption is harmless, despite

7 strong evidence to the contrary.

8 Low-carbohydrate diets tend to result

9 in reduced intake of fiber, a underconsumed

10 nutrient; and increased intake of animal protein,

11 cholesterol, saturated fat, all of which are

12 overconsumed by Americans and a risk factor for

13 mortality and cardiovascular disease.

14 A prospective cohort study and

15 meta-analysis published in the Lancet Journal in

16 2018 investigated the association between dietary

17 carbohydrate intake and mortality, and the

18 researchers found that mortality increased when

19 carbohydrates were exchanged for animal-derived

20 fat or protein, and mortality decreased when the

21 substitutions were plant-based.

22 Research shows that a low-carbohydrate,


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1 high-protein diet is not helpful and leads to poor

2 endothelial function, higher C-reactive protein,

3 which is a marker of inflammation; stiffer

4 arteries, higher cardiovascular risk, higher

5 cardiovascular mortality, higher cancer mortality,

6 and just higher overall mortality.

7 Unlike a low-carbohydrate diet, a

8 plant-centered diet high in complex, unrefined

9 carbohydrates from whole plant foods have proven to

10 reverse heart disease and signs of early-stage

11 prostate cancer in randomized controlled trials.

12 I encourage the Committee to set

13 guidelines that follow the science. Make it clear

14 to Americans what foods should they be consuming

15 more of; mainly, more minimally processed plant

16 foods, such as fruits, vegetables, whole grains,

17 and legumes.

18 I also encourage the Committee to make

19 it clear which foods Americans should be eating less

20 of, namely animal-based foods such as meat, dairy

21 and eggs. Thank you for the opportunity for me to

22 speak today.


259


2 Commenter number 41.

3 MR. JOHNSON: Hi, everybody. I’m Guy

4 Johnson, executive director of the McCormick

5 Science Institute, and perhaps, not unsurprisingly

6 today, I have one word for you, flavor.

7 Or if you prefer, we could use the word

8 that Dr. Mattes has been using, palatability.

9 Whatever you call it, 86 percent of consumers,

10 according to IFIC’s latest data, think it’s the most

11 important factor that they have in determining what

12 foods to buy and eat, which makes it one of the

13 biggest barriers to the consumption of healthier

14 foods, but I’m here to tell you that it does not need

15 to be that way.

16 You can add flavor to healthy foods

17 without sugar, fat, salt or calories in a variety

18 of ways. Take spices and herbs, for example.

19 There are controlled intervention

20 studies that show that spices and herbs can increase

21 the consumption of fruits and vegetables in a high

22 school cafeteria setting by 15 to 20 percent.


260

1 Spices and herbs have helped

2 free-living adults lower their sodium intake by

3 almost 1,000 milligrams a day over a five-month

4 period. And spices and herbs can compensate for

5 the loss of flavor or palatability in foods that

6 have reduced in saturated fat by 60 to 65 percent

7 and added sugar by a third.

8 And I’m here with some good news.

9 There’s a brand-new study conducted in France that

10 shows that a pulse hummus-type appetizer with

11 cumin, ginger, shallots and a little bit of garlic

12 reduced the loss in palatability of a 50-percent

13 reduction in sodium.

14 And there’s more research on the way.

15 So the current Dietary Guidelines do a pretty good

16 job of starting out on this by recommending that

17 spices and herbs be used to flavor foods, rather

18 than salt.

19 But we’ve got a long way to go. The data

20 you presented yesterday shows that a lot of people

21 are not meeting the Dietary Guidelines. And so I

22 think flavor is your best shot at making it happen.


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1 So what I’m going to ask you to do, when

2 you’re writing a report, think of yourselves as not

3 only scientists, which obviously you are, but

4 consumers, which you also are, and look for ways to

5 use the Guidelines to remove some of those barriers

6 to healthier eating.

7 Maybe even make it fun, like Dr. Boushey

8 said yesterday, and I think we can do it, even with

9 those burgers and sandwiches.

10 Thank you very much.



13 MS. MCGUIRE: Good afternoon. My name

14 is Jennifer McGuire, and I am a registered dietitian

15 with expertise in nutrition communication. I work

16 for the National Fisheries Institute and spend much

17 of my time following the latest seafood science, and

18 translating it for media, fellow health care

19 professionals, and families.

20 The studies about the beneficial role in

21 seafood in brain development and health, as well as

22 heart health, have been captured in your literature


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1 review, and speak for themselves. So I’m not going

2 to get into that.

3 Instead, today I’m going to focus on

4 what the science says about the quantifiable impact

5 of Americans’ low seafood consumption on public

6 health.

7 Starting at the beginning, pregnant

8 women in this country eat less than two ounces of

9 seafood per week. This is less than one-quarter of

10 the 2015 Dietary Guidelines’ recommendation to eat

11 eight to 12 ounces or two to three servings of

12 seafood each week during pregnancy. So how does

13 that translate into health impacts?

14 Based on data from the FDA’s net effects

15 of eating commercial fish assessment, the very low

16 amount of seafood a pregnant women in the U.S.

17 currently eats contributes 0.7 points to her baby’s

18 IQ.

19 While that’s certainly better than

20 nothing, she can boost her baby’s IQ by 3.2 IQ points

21 by eating the recommended amount of seafood.

22 Unfortunately, the low seafood intake


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1 that most expecting moms eat in this country leaves

2 2.5 IQ points on the table per baby, for a

3 population-wide loss of about 9.5 million IQ points

4 annually.

5 Moving on to the impacts of seafood

6 deficiency on heart health, a December 2019 study

7 published by Plos Medicine estimated the annual

8 heart disease and type 2 diabetes costs in the U.S.

9 associated with suboptimal intake of 10 food

10 groups.

11 These included things like fruits,

12 vegetables, seafood, nuts and seeds, grains,

13 sugar-sweetened beverages, sodium, all of the food

14 groups that y’all are looking at.

15 Researchers found the second-largest

16 contributor to costs is low consumption of seafood

17 omega-3s, accounting for $1.27 billion in heart

18 disease costs per year.

19 Researchers conclude the mean

20 consumption of seafood in the U.S. is extremely low,

21 and thus there is much to gain from an increase to

22 ideal levels of consumption.


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1 As you create your report, I implore you

2 to keep in mind, not only what the science shows

3 about the health benefits of eating certain foods,

4 but the relative magnitude of those benefits.

5 Thank you.


7 number 43.

8 MR. DIAMOND: Good afternoon. My name

9 is Larry Diamond. I am a health coach and

10 researcher from Austin, Texas, and I want to paint

11 a picture of January 2013, seven years ago, what my

12 health state was like at that time.

13 I had been morbidly obese for well over

14 20 years, my entire adult life. I had all five

15 markers of metabolic syndrome. I was constantly

16 hungry, and I was also constantly tired.

17 And I had an epiphany. What if, instead

18 of the cause of my obesity being eating more and

19 moving less, what if that was a result of the diet

20 that I was following? And I was very much following

21 a high-carb recommended Dietary Guidelines of real

22 foods.


265

1 But for me, that was keeping me

2 constantly in a state of high insulin. I had blood

3 sugar swings. So I was hungry every few hours. I

4 remember not being able to go as much as I wanted

5 to, more than a few hours, without eating.

6 And I had a family. I had advanced

7 degrees. Like many, many Americans, why couldn’t

8 I stop eating? So I decided to delve into that

9 aspect of my life, and I found that low-carb,

10 real-food diets, between 50 grams and 130 grams,

11 created a condition called fat adaptation, that was

12 the breakthrough that saved my life.

13 And at the time, seven years ago, I had

14 a newly adopted daughter with my wife, and I did not

15 think that I would be alive today. So what is fat

16 adaptation, and why should a low-carbohydrate

17 option included in the Dietary Guidelines?

18 Fat adaptation means that, during the

19 day, we run on free-fatty acids and ketones. Those

20 are clean-burning fuels for organs. You spare

21 glucose for the few cells that need it in the brain,

22 the red blood cells.


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1 You have steady blood glucose. You

2 reverse metabolic syndrome. My trigs over HDL went

3 from seven to well under one. You’re never hungry

4 because you have access with your own body fat at

5 all times.

6 So my family is healthy. My wife lost

7 70 pounds. I lost 120. We’re terrifically

8 energetic. Please include this option for all

9 Americans. Thank you.


11 We’ll move to commenter number 44.

12 DR. EYTAN: Good afternoon. My name is

13 Ted Eytan, and I’m a family medicine specialist

14 residing in Washington, D.C., here on behalf of The

15 Nutrition Coalition. I have no ties to

16 pharmaceutical, food or device manufacturers,

17 because screening for conflicts of interest is

18 important.

19 It’s amazing to be here in 2020, because

20 I grew up with the first Dietary Guidelines in

21 Phoenix, Arizona. I remember how my family

22 responded to the mass media messages and how


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1 dramatically the food environment changed.

2 For me, I was calorie-restricting as

3 early as age 12, unable to control my weight or

4 appetite, and this is not normal. Kids, indeed all

5 of us, should feel satiated from eating a

6 nutrient-dense, minimally processed food diet, and

7 we should exist at a normal weight without much

8 thought, and then lead long, productive, healthy

9 lives.

10 It is now 2020, and when someone says

11 they’re eating healthy, we don’t know what that

12 means anymore. It might seem like a group like ours

13 wants one specific dietary pattern endorsement in

14 the 2020 DGA.

15 This is not the case. Our goal is that

16 nutrition policy be based on rigorous scientific

17 evidence. We care that the recommendations that go

18 out to all Americans be trustworthy, reliable, and

19 up to date.

20 The process for reviewing the science

21 needs to be based on an accepted state-of-the-art

22 methodology like GRADE or Cochrane. With


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1 grade-limited evidence as you showed yesterday, it

2 would be proper both to not issue recommendation or

3 issue a weak recommendation, which would allow

4 health professionals to tailor their care to the

5 needs of the people they serve.

6 We only have to remember the reversals

7 on dietary cholesterol and low-fat diet to be

8 reminded that caution is far better than

9 overstepping what the science reliably tell us. We

10 applaud you for considering a greater range of

11 dietary patterns as well as types of dietary fats

12 in the topics and questions under review.

13 These include importantly the continued

14 caps on saturated fats. These fats have been

15 tested in rigorous clinical trials on tens of

16 thousands of people in studies funded by the NIH,

17 yet no Dietary Guidelines committee has ever

18 directly reviewed them.

19 They are excluded from your review

20 because they took place prior to 1990. Nineteen

21 systematic reviews including these trials have been

22 published since 2010. Please include this data in


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1 your review.

2 This is gold standard data, and it

3 should not be ignored. Yesterday, we saw the

4 horrific data regarding the metabolic health of

5 Americans. Have you given up on the idea that the

6 DGAs should reduce chronic illness instead of

7 accept its increased prevalence?

8 Quoting the 2015 Guidelines: "These

9 Guidelines embody the idea that the healthy eating

10 pattern is not a rigid prescription but rather an

11 adaptable framework in which individuals can enjoy

12 foods that meet their personal, cultural and

13 traditional preferences."

14 This is what we need, a true range of

15 dietary patterns based on rigorous clinical trial

16 evidence. This would be a DGA we’d all be proud of.

17 We’re here to eliminate metabolic illness with you.

18 Thank you.


20 Next, commenter number 45.

21 DR. MILLER: My name is Dr. Debra

22 Miller, and I’m the senior vice president for


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1 scientific and regulatory affairs at the National

2 Confectioners Association, or NCA. We thank the

3 DGAC for this opportunity to appear before you

4 today.

5 NCA is the leading association

6 representing the U.S. chocolate and candymakers.

7 I likely do not need to tell you all, but consumers

8 love the products that our members produce.

9 In these brief comments, we would like

10 to provide some insight on our special and unique

11 category and outline our industry’s voluntary

12 efforts to help consumers manage their calorie and

13 sugar intake.

14 We also strongly encourage the DGAC to

15 recognize the key role that portion control and

16 portion balance must play in the 2020-2025 Dietary

17 Guidelines.

18 So despite an array of consumer

19 education efforts, including mandatory nutrition

20 labeling and, more recently, restaurant menu

21 labeling, obesity remains the nation’s most

22 critical nutrition issue.


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1 Over the past four decades, researchers

2 have documented that the sizes of meals, snacks, and

3 beverages have increased rather dramatically. One

4 promising and, we think, underutilized strategy for

5 taking this issue is to help consumers to understand

6 and consume appropriate-sized portions.

7 The importance of portion control is

8 recognized by leading authorities including the

9 American Heart Association, the American Cancer

10 Society, and the CDC. Emphasis on portion control

11 allows individuals to enjoy the foods that they love

12 within the context of a balanced diet.

13 Chocolate and candy products are

14 unique. They have long been associated with

15 gifting, holiday traditions, family celebrations

16 and the like. Consumers appreciate the unique role

17 that chocolate and candy can play as an occasional

18 treat in a happy and balanced lifestyle.

19 They further understand that these

20 treats generally contain some sugar. Because our

21 members understand the connection that consumers

22 have to the products we make, our industry is


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1 committed to helping consumers manage their calorie

2 and sugar intake, while still enjoying their

3 favorite treats.

4 To that end, in 2017, the confectionary

5 industry launched the Always a Treat Initiative.

6 As part of this initiative, over the next few years,

7 consumers will see more options in smaller-sized

8 packages and innovative new products.

9 We are proud to make this commitment

10 with the Partnership for a Healthier America, who

11 will help us track our progress and verify this a

12 meaningful initiative.

13 It is important to note that sugar is an

14 essential ingredient in chocolate and candy, and

15 not only does sugar provide sweetness, but it also

16 provides structure and texture in confections.

17 According to NHANES data, most

18 Americans have candy about two or three times a

19 week, for about 40 calories, and about five grams

20 of added sugar per day from those confectionary

21 items.

22 Thus the average amount of candy can fit


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1 into the U.S. dietary -- the daily value for added

2 sugar. While our industry understands that the

3 Dietary Guidelines on added sugar is important, we

4 also believe that incorporating --


6 DR. MILLER: -- a treat on occasion is

7 important as well.

8 MS. BROWN: Thank you. With

9 additional time, we’ll move to commenters on the

10 standby list originally, beginning with number 46.

11 No? Forty-seven?

12 DR. GUSTIN: I’m Dr. Anthony Gustin.

13 I’m a sports medicine and functional medicine

14 clinician from Austin, Texas, and I’ve seen

15 firsthand the power of nutrition in practice.

16 Using my clinical experience I’ve scaled a

17 whole-food, low-carb platform that over 45 million

18 people have engaged with.

19 Results have been incredible.

20 Thousands of people have used real-food, low-carb

21 diets to fix insulin resistance, diabetes, obesity

22 and more. I’m not against real-food


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1 carbohydrates, rather for the recognition and

2 inclusion of low-carb, defined as 25 percent or less

3 of total calories from carb as a dietary option for

4 people who may benefit from it.

5 Over 60 percent of Americans have

6 chronic disease and could benefit from this

7 approach, and the current 45 percent guideline

8 won’t be enough to turn their health around. I have

9 full confidence that when the Dietary Guidelines

10 are refreshed, we will collectively be intelligent

11 enough to incorporate the results from hundreds of

12 low-carb studies that we’ve seen in the last five

13 years, much like the ADA has done recently.

14 More concerning to me is when you

15 recommend a healthy, low-carb nutrition pattern,

16 where the energy will come from. If you reduce

17 carbs, you have to increase fat. However, the

18 current Guidelines demonize saturated fat and

19 promote polyunsaturated fat.

20 I understand the concern that saturated

21 fats lead to heart disease. When you look at the

22 science, it just doesn’t hold up. This is not too


275

1 dissimilar to the old recommendations for

2 cholesterol that didn’t pan out.

3 Listening to everybody today, I know

4 that’s going to be an unpopular opinion, but so was

5 banning trans fat 30 years ago. Real food is not

6 the problem. Saturated fat has been consumed for

7 literally all human history, yet heart disease only

8 started to become the killer it is over the last 100

9 years, not coincidentally, exactly when seed oils

10 were the recommended polyunsaturated fats when the

11 current Guidelines were first introduced.

12 Saturated fats are stable in the body

13 and not easily oxidized. They’re used for things

14 like energy metabolism, hormone production, cell

15 membranes, nervous system maintenance and more.

16 Saturated fats are naturally found in both animal

17 and plant foods, and the majority of fat in breast

18 milk. The best food for a developing human is

19 saturated fat.

20 Humans do not lose the ability to use

21 saturated fat after childhood. Polyunsaturated

22 fats, by comparison, are highly reactive molecules.


276

1 They are many carbon double bonds

2 reacting violently with oxygen, like firecrackers

3 in the body. This peroxidation cascade results in

4 highly toxic compounds, mitochrondrial and DNA

5 damage in oxidation of LDL particles.

6 Polyunsaturated fats come from heavily

7 processed seeds going into oil. This process takes

8 massive machinery and many chemicals. No human in

9 history was ever able to eat the nutrient-void

10 processed fat from thousands of seeds until the last

11 100 years.

12 I agree with the stance of this

13 Committee that people should be eating

14 nutrient-dense whole foods. The reality is real

15 foods highest in nutrition per gram are those that

16 include saturated fat.

17 Reducing polyunsaturated fat by

18 allowing saturated fat shouldn’t be controversial.

19 You are literally replacing nutrient-void,

20 chemical-rich processed fake foods and industrial

21 seed oils with natural, nutrient-rich whole foods

22 that have saturated fat.


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1 There doesn’t need to be a target for

2 saturated fat, rather a removal of the current

3 limitation, much like how the cholesterol

4 limitation was dropped from the current Guidelines.

5 This will allow people to get the most amount of

6 nutrition per gram of food, while minimizing toxic

7 seed oils.

8 Please make the right call and drop any

9 limitation to saturated fat, much like you did with

10 cholesterol in 2015. Thank you.

11 MS. BROWN: Thank you. Commenter 48.

12 MS. MULLER: Hello. My name is

13 Michelle Muller, and I am co-founder of Little

14 Spoon, an early childhood nutrition company, for

15 birth to eight years. Thank you to the Committee

16 for lending your accessibility to the public today.

17 For quick context, I’ve been building

18 Little Spoon for more than three years, launching

19 our delivery service for cold-pressed organic baby

20 food nationally in 2017. We offer a comprehensive

21 nutrition solution, taking into account where

22 children are developmentally and in their


278

1 starting-solids journey, and then provide

2 recommendations for a full baby food meal plan.

3 In 2019, we launched a line of vitamins,

4 probiotics and homeopathic remedies for an

5 additional layer of health support. At Little

6 Spoon, we know quality nutrition is critical during

7 the first years of life to set up a lifelong healthy

8 relationship with food.

9 As such, I have three areas I recommend

10 this Committee focus on as they write the Guidelines

11 for the next generation: spoon feeding, variety,

12 and limiting processed foods.

13 In the last public meeting, Dr. Kay

14 Dewey, the chair of the Birth to 24 Months

15 Subcommittee, stated that the Committee will be

16 looking more to what to feed and what not addressing

17 how to feed infants and toddlers, which I hope you

18 will all reconsider.

19 At Little Spoon, we strongly believe

20 that parents should choose spoon feeding over pouch

21 feeding. Pouches can be a convenient, on-the-go

22 option for those in-between snack moments and


279

1 special medical cases, but there is mounting

2 research suggesting pouches can hinder healthy

3 development of eating skills.

4 Spoon feeding allows your baby to learn

5 to chew and experience sensory properties like

6 aroma, texture, color and taste. Self-feeding

7 also directly contributes to the development of

8 motor skills, hand-mouth and hand-eye

9 coordination, plus critical habits like taking

10 breaks between bites and stopping when full.

11 Drinking a full meal through a pouch

12 spout facilitates a lack of portion control and

13 negative eating habits that we know can lead

14 directly to obesity, type 2 diabetes, and other

15 disorders plaguing our health system.

16 We know there is not one magical

17 superfood, but rather a variety of foods that

18 provide a nutritional punch when consumed together.

19 Serving babies complementary foods from all colors

20 of the rainbow is a great way to ensure they are

21 receiving a myriad of nutrients.

22 Avoiding processed foods is also a must,


280

1 so we strongly believe that a baby’s first bite of

2 food should be a fruit or a vegetable, instead of

3 overly processed cereals like rice or oatmeal.

4 Scientists are learning more about the

5 microbiome, its critical role in overall digestive

6 health, and the positive impacts of probiotics on

7 immunity. I encourage the Committee to include a

8 stance in guidance on the use of probiotics in

9 infancy and childhood.

10 In the adult nutrition guidelines, the

11 USDA recommends whole vegetables, fruits and

12 grains, and recommends to limit added sugars, salt,

13 saturated and trans fats, ingredients solely found

14 in processed foods.

15 Please consider that how baby and

16 toddler food is processed matters. The heat

17 processing that most shelf-stable brands use are

18 rendering the food commercially sterile, lacking

19 vitamins and nutrients, all critical for healthy

20 development.

21 This is not to say we should ban

22 shelf-stable baby food, but the fact that it’s 2020


281

1 and there is no transparent recommendation on the

2 benefits of feeding babies fresh food over --


4 MS. MULLER: -- commercially sterile

5 food is creepy. Thank you.


7 Next, we’ll move to 49. Forty-nine? No? Fifty?

8 Do we want to go next on that side, then, 51?

9 Fifty-two? Okay. We’ve got one, commenter 52.

10 DR. ALI: I’ve been a practicing

11 cardiologist for about 30 years, and I have served

12 in several leadership positions at Baylor College

13 of Medicine and HCA Houston Health Care.

14 For the first 24 years of my practice,

15 I advised my patients to follow a low-fat, healthy

16 whole-grain diet, with emphasis on fruits,

17 vegetables, and a reduction in animal food, sugar,

18 and saturated fat.

19 My patients did not improve on this

20 diet, despite being disciplined and following my

21 recommendations. I saw them gradually becoming

22 prediabetic or diabetic, increase their weight and


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1 worsen their cholesterol. Many progressed to

2 overt heart disease.

3 It was a dreadful experience to go to my

4 office, because I felt I was ineffective and

5 increasingly reliant on medications that made their

6 lives worse.

7 About six years ago, because of my own

8 personal experience, I began a low-carb diet, and

9 I stand before you 30 pounds lighter and also

10 applying the science of low carb for my patients.

11 I come across over 100 patients on a

12 weekly basis. I have seen patients in their 70s,

13 80s and 90s improve on a low-carb diet and

14 intermittent fasting. One practice reinforces the

15 other.

16 Not only have I seen 30 to 50 pounds of

17 weight loss, I have consistently seen them improve

18 their blood sugar, their blood pressure, and their

19 cholesterol quality.

20 They’ve been able to stop many

21 medications, diabetic, blood pressure, and

22 lipid-lowering medications. This has been a


283

1 transformative experience for me. My patient

2 interaction is reinforced on a daily basis by our

3 collective victory in their health.

4 I constantly hear them talking about

5 being satiated and having control over their hunger

6 on a true low-carb diet, which should mean less than

7 20 percent of calories coming from carbs.

8 Let us not forget that as humans our

9 brain is 1,000 grams bigger than our closest ape

10 ancestor. This is because we ate nutrient- and

11 calorie-dense animal food and learned the art of

12 cooking.

13 I humbly submit that a low-carb diet is

14 a paradigm whose time has come for DGA to include

15 it as an option.

16 While I cannot go into the science

17 behind the low-carb diet in such a short time, there

18 are plenty of robust clinical trials that give us

19 the information that it decreases blood sugar,

20 blood pressure, and improves cholesterol quality.

21 Thank you.



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1 MR. REYNOLDS: My name is Doug

2 Reynolds, representing Low Carb USA. After

3 discovering the concept of carbohydrate

4 restriction and reversing my own health issues, I

5 established Low Carb USA to provide a platform for

6 others to learn what I did not know until I was 51.

7 It’s important to recognize that this

8 field has a growing mountain of rigorous clinical

9 trial evidence behind it. While we applaud the

10 initiative of the Committee for proposing to add a

11 low-carb dietary pattern to the 2020 Guidelines, I

12 do have grave concerns about the current proposed

13 definitions for that pattern.

14 A threshold of 45 percent of calories

15 from carbs doesn’t even come close to defining a

16 low-carb diet. A separate analysis of the

17 scientific literature, looking only at studies

18 below 25 percent, is encouraged, because this is the

19 upper limit of the threshold.

20 More important would be to

21 additionally define a ketogenic subcategory

22 advising 10 percent or less. The differences you


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1 will see in each of these groups is vast.

2 At levels below 25 percent, we eliminate

3 sugar and processed carbohydrates and basically

4 just eat real food, which results in enormous

5 improvements in general health. Low Carb USA

6 established a panel of advisors of highly respected

7 scientists and physicians from around the world,

8 and in May 2019, we published a set of clinical

9 guidelines for therapeutic carbohydrate reduction

10 as an intervention for use by physicians.

11 This identifies a number of low-carb

12 categories with thresholds defining grams of carbs

13 as opposed to percentages. The two lowest of these

14 are very low-carb ketogenic, which is less than 30

15 grams, and low-carb ketogenic 30 to 50 grams.

16 It’s at these levels that the magic

17 happens. In other words, significant metabolic

18 changes occur, including drastically reduced

19 levels of inflammation, resulting in reduced

20 chronic disease.

21 There are now hundreds of thousands of

22 documented clinical cases with the reversal of many


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1 chronic diseases, like type 2 diabetes,

2 non-alcoholic fatty liver disease, all thought

3 previously to be incurable. And every day, we hear

4 about more.

5 The truth is that adding the currently

6 proposed low-carb pattern will do far more harm than

7 good. The Dietary Guidelines are supposed to be

8 only for healthy people, but this is only about 12

9 percent of the population.

10 The reality is that the Guidelines are

11 highly influential in establishing the food

12 policies of most institutions, like hospitals,

13 schools and our military, and they set the gold

14 standard for clinical trials.

15 Running a clinical trial comparing any

16 other dietary pattern against a so-called low-carb

17 pattern consisting of 40 to 45 percent carbs would

18 just result in more inconclusive evidence, because

19 it’s not low-carb.

20 I hope you will recommend guidelines

21 with a true range of dietary patterns for all

22 Americans, including the vast majority of us


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1 struggling with the diet-related diseases, not just

2 a tiny elite portion.

3 Thank you.

4 MS. BROWN: Thank you. Next on this

5 side, commenter 56?

6 DR. NGUYEN: Hello. My name is Dr.

7 Tiffany Nguyen, and I’m a general pediatrician in

8 the Houston area, working at Texas Children’s

9 Pediatrics for the last 16 years.

10 I would like to speak from my experience

11 with the pediatric population and urge the

12 Committee to put a greater emphasis on fiber.

13 Here’s why. Constipation and obesity

14 are two of the most common problems I see in my

15 practice. In fact, a high percentage of my

16 patients with abdominal pain are merely suffering

17 from constipation, and more than 30 percent of my

18 checkup visits reveal patients in the overweight or

19 obesity range.

20 Increasing fiber intake is a proven,

21 simple, and practical approach to help remedy these

22 problems. In a study by Schmier and others in 2014,


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1 increasing fiber intakes by three grams in just half

2 of the U.S. population may relieve enough

3 constipation to save an estimated $12 billion in

4 health care costs. Basically just reaching for an

5 extra apple or a banana a day is all it takes.

6 Recent expert studies revealed more

7 than 40 percent of kids have obesity by their late

8 teens, and it’s predicted that by the year 2030,

9 about half of the population will have obesity.

10 Obese patients are at increased risk of

11 developing many medical problems, including

12 diabetes, hypertension, high cholesterol, stroke,

13 osteoarthritis requiring hip and knee

14 replacements, and even certain cancers.

15 Preventing obesity then is the ideal

16 solution. Fiber promotes weight loss and prevents

17 weight gain. It stabilizes blood sugar and

18 decreases cholesterol, and it protects against

19 constipation and colon cancer.

20 Parents often come into my practice

21 expressing their concern that the children are not

22 getting enough protein in their diet, and yet


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1 studies show that more than 97 percent of Americans

2 do get enough protein, but in contrast, more than

3 97 percent of Americans do not get enough fiber.

4 Fiber deficiency then is the more

5 practical concern. A recommendation from the

6 Committee can boost public awareness and promote

7 increased fiber intake. Increased need for fiber

8 will compel business and agriculture to supply its

9 demand.

10 Together we can respectfully align

11 science, medicine, food industry, and public

12 education to promote a healthier and happier

13 lifestyles and drive down health care costs.

14 Although an apple of day may not keep the doctor

15 away, it’s a simple step towards better health for

16 our community.

17 Thank you.


19 MS. MOHAMEDSHAH: Hello. I am Farida

20 Mohamedshah with the Institute of Food

21 Technologists, IFT. IFT is a global organization

22 of nearly 16,000 individual members from more than


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1 100 countries.

2 IFT brings together the brightest minds

3 in food science, technology and related professions

4 from academia, government and industry to solve the

5 world’s greatest food challenges. We believe that

6 science is essential to ensuring a global food

7 supply that is sustainable, safe, nutritious and

8 accessible to all.

9 We appreciate the opportunity to

10 provide input on the 2020 Dietary Guidelines for

11 Americans, DGAs. IFT underscores the importance

12 of ensuring that the recommendations regarding food

13 and nutrient intake are evidence based.

14 We urge the Committee to continue the

15 focus on evidence-based healthy eating patterns,

16 such as those identified in the 2015-2020 DGAs, that

17 epitomize a healthy diet, support food-based

18 dietary recommendations to meet nutrient needs, and

19 recognize that all food groups and foods, including

20 processed foods, can be part of healthy eating

21 patterns.

22 It is also critical that the recommended


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1 healthy eating patterns allow consumers to have

2 enjoyable eating experiences and meet their

3 personal, cultural, lifestyle, and budgetary

4 needs.

5 Food science and technology are

6 invaluable in the development, production and

7 availability of foods that can be part of healthy

8 eating patterns, while also meeting our personal,

9 cultural and other lifestyle needs.

10 It is important to recognize that fresh

11 and locally grown foods alone are insufficient both

12 in the amount and distribution to meet the nutrition

13 requirements of the growing and diverse population,

14 or the particular needs at each life stage, at all

15 socioeconomic levels.

16 Hence food processing is crucial.

17 Through the application of food science

18 and technology, food processing helps transform raw

19 food materials and ingredients into a variety of

20 safe, nutritious, palatable, accessible,

21 convenient, and affordable foods that are available

22 year-round.


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1 Although in some instances, food

2 processing may reduce some nutrients, in others it

3 increases long-term retention and bioavailability

4 of some nutrients and food components.

5 For example, processing makes the

6 important antioxidant lycopene more available from

7 canned rather fresh tomatoes. Food fortification

8 and reformulation are proven to address nutrient

9 concerns such as additional vitamin D or reducing

10 the use of food components such as added sugars.

11 Yet without food safety and

12 sustainability, efforts to improve nutrient and

13 diet quality may be ineffective. IFT urges that

14 the Committee and the Departments of Agriculture

15 and Health and Human Services engage food

16 scientists and technologists in the deliberation

17 process.

18 Their insights and diverse ranges of

19 expertise are critical to the discussion of healthy

20 dietary patterns and implementation of at-scale

21 solutions that address consumer acceptance, taste,

22 convenience, affordability and accessibility.


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1 In addition to nutrition and food

2 science, it is critical to address consumer

3 dynamics and behavior as germane drivers --


5 MS. MOHAMEDSHAH: -- for consumer

6 adoption of nutritious food products --


8 MS. MOHAMEDSHAH: Thank you.

9 MS. BROWN: We’ll next move to this

10 side, commenter number 58. Thank you.

11 DR. SMIGEL: Yes. Thank you. My

12 name’s Dr. Jacob Smigel. I’m an emergency

13 physician, board-certified in emergency medicine,

14 and I’ve been working in the hill country outside

15 Austin, Texas, for the past five years or so.

16 I had a little bit of a Doc Hollywood

17 experience going out there I think, and it’s been

18 beautiful. But I find that I’m doing different

19 work than maybe I’d imagined I would do or that you

20 imagined I would do.

21 Most of my time is spent not treating

22 emergencies as you might imagine them, like falling


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1 off of scaffolds, or run over by cars, but rather

2 dealing with the acute presentation of chronic

3 disease, non-life-threatening heart attacks,

4 strokes, diabetic complications, hypertension, for

5 instance.

6 And that really comes to no surprise to

7 you, because it’s actually truly the bread and

8 butter of emergency medicine. And I’ve had an

9 interesting nutrition since medical school. I got

10 a modicum of nutrition training in medical school.

11 It got excited and it made me curious,

12 and I’ve been asking patients what they think about

13 nutrition or what they think about healthy diets?

14 And what I can ascertain from five years of spending

15 time in Burnet, Texas -- and I’m representing those

16 people here today -- is that most people’s

17 perception of diet has to do with three facts that

18 they’re sure of: protein is good, got to get your

19 protein; all carbs are bad; and bananas have a whole

20 lot of potassium in them. That basically sums up

21 their nutritional knowledge of most people.

22 And furthermore, there’s a disconnect,


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1 because when I ask them, do you think the foods that

2 you’re eating could make you sick? They say, oh,

3 yeah. Do you think maybe changing the foods that

4 you eat could make you well? I don’t know. They

5 don’t seem to think so. There’s a clear disconnect

6 there for me. And that’s why I think we need clear

7 public health messaging, the clearer the messaging

8 the better.

9 This works in regards to public smoking

10 or smoking campaigns or wearing seatbelts or safe

11 sex practices. This is how we change the health of

12 the public. And I’m here today to urge you for

13 clear messaging regarding the optimal diet for

14 human health.

15 I note from the 2015 Guidelines, for

16 instance, a notation that there’s strong evidence,

17 from mostly prospective cohort studies but also

18 randomized controlled trials, having shown that

19 eating patterns that include lower intake of meats

20 as well as processed meats and processed poultry are

21 associated with reduced risk of cardiovascular

22 disease in adults.


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1 Moderate evidence indicates that these

2 eating patterns are associated with reduced risk of

3 obesity, type 2 diabetes, and some types of cancer,

4 the scourge of the ER, if not all health care

5 professionals.

6 And I imagine a continuum of clear

7 recommendations from grade school through

8 adulthood that this is demonstrated in public

9 institutions, in our public schools, and I would

10 recommend to the panel to recommend one dietary

11 pattern, recommended to eat a whole-food,

12 plant-based diet, as has been mentioned before, but

13 around whole grains, beans and pulses, fruits,

14 vegetables, nuts and seeds as the optimal way to

15 make big changes to get big results.

16 MS. BROWN: Thank you. Could we have

17 commenter 59? Sixty?

18 MR. LEAR: Good afternoon. I am Al

19 Lear, director of science and research for the

20 International Bottled Water Association, IBWA.

21 Water, including tap, filtered and bottled, plays

22 a vital role in supporting nutritional health.


297

1 IBWA applauds the 2015 Dietary

2 Guidelines for recognizing the importance of water

3 in a healthy diet, and we were glad to see inclusion

4 of water as a topic under beverages by the 2020

5 Dietary Guidelines Advisory Committee.

6 Scientific research shows that drinking

7 water positively influences overall well-being and

8 supports a number of healthy bodily functions and

9 organs. The Centers for Disease Prevention and

10 Control’s Drinking Water Fact Sheet recommends that

11 drinking enough water every day is good for overall

12 health.

13 As plain drinking water has zero

14 calories, it can also help with managing body weight

15 and reducing caloric intake when substituted for

16 drinks with calories. We were glad to see that the

17 2020 Dietary Guidelines will include a focus on

18 children from birth to 24 months, because the

19 development of chronic diseases starts at an early

20 age, and so do good drinking habits.

21 Consistent with CDC recommendations,

22 consumption of breast milk or infant formula, along


298

1 with the introduction of water for children between

2 six and 12 months old, is encouraged. As the

3 Committee reviews the hydration needs for all age

4 groups, IBWA urges special consideration for

5 hydration requirements for adults 65 and older.

6 Proper hydration is an important

7 consideration for the well-being of everyone, but

8 it is of increased importance for older adults, as

9 noted in the National Center for Health Statistics

10 Data Brief, which notes that previous studies have

11 shown that adults aged 60 and older are among the

12 most vulnerable to dehydration.

13 In terms of consumer education, the

14 importance of water in a healthy diet is recognized

15 by 48 countries throughout the world, who promote

16 water consumption in the nutritional guidance

17 graphics.

18 However, water is noticeably absent in

19 the most prominent educational tool that the United

20 States Government uses to promote a healthy diet,

21 the My Plate nutritional guidance graphic.

22 Water, in addition to the presence of


299

1 dairy, should be included on the My Plate

2 nutritional graphic, since it is critical to good

3 health.

4 The National Drinking Water Alliance

5 recently submitted a comment to the Dietary

6 Guidelines Advisory Committee signed by 62

7 individuals and 13 organizations comprising

8 researchers, scientists, nutritionists,

9 clinicians, public health professionals, and

10 public health advocates, urging that both the

11 Dietary Guidelines for Americans and My Plate

12 clearly and consistently encourage the benefits of

13 water consumption in place of sugar-sweetened

14 beverages.

15 Thank you for the opportunity to provide

16 comments this afternoon. IBWA supports the work of

17 the Advisory Committee and will continue working

18 with the Advisory Committee, USDA and HHS staff as

19 you prepare the 2020 Guidelines for Americans.

20 MS. BROWN: Thank you. We’ll move to

21 our last commenter before closing remarks, number

22 61.


300

1 DR. McADAMS: Good afternoon. I’m Dr.

2 Molly McAdams. I’m a rancher and steward of the

3 land. I’m also a PhD-level scientist, a

4 businesswoman, and the mother of a teenaged

5 athlete.

6 My family’s Texas ranch, which is about

7 90 miles north of here, has operated and provided

8 beef to Americans since the 1830s. Across the

9 human lifespan, beef is a great-tasting,

10 nutrient-rich food that plays an important role in

11 any healthy diet, including healthy pregnancies,

12 growth and development of children, adults who want

13 to maintain strength and energy, older Americans

14 who want to age vibrantly.

15 Beef delivers great nutrition as a

16 single-ingredient real food that people enjoy

17 eating. As a supporter of the National Cattlemen’s

18 Beef Association and through the Beef Check-off,

19 I’ve proudly contributed to scientific research

20 about this nutrient-rich food.

21 And thanks to cattle-raising practices,

22 beef is leaner than ever before. Over 20


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1 gold-standard studies have shown that beef

2 contributes favorably to heart health and other

3 positive health outcomes, and today the amount of

4 beef we eat is consistent with what science shows

5 to support healthy diets and is within current DGA

6 recommendations.

7 We don’t need to cut back on beef intake

8 to get a healthier diet. Rather, we should eat more

9 nutrient-rich foods and less empty calories.

10 History and science have shown that limiting meat

11 doesn’t help people eat better and can actually lead

12 to overconsumption of refined carbs, as well as

13 foods high in added sugars and sodium.

14 Research now shows that plant-based

15 diets aren’t a silver bullet, either. In addition,

16 many Americans benefit from a low-carb,

17 higher-protein diet with meat, and DGA should

18 encourage this choice.

19 I’m a former grocery executive who led

20 product development and health and wellness. I can

21 tell you that America’s favorite protein food is

22 beef. What a great opportunity, because beef pairs


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1 perfectly with foods people aren’t eating enough

2 of, like vegetables and whole grain.

3 In fact, many Americans would benefit

4 from getting more nutrients like protein, iron, B

5 vitamins and choline, all of which are easily found

6 in beef but are not as easily found in plant foods.

7 On behalf of all who grow cattle, which

8 are uniquely suited to convert inedible plants into

9 high-quality, nourishing protein for humans to

10 enjoy, and all of this is done on land that’s not

11 suitable for farming crops, and as the mom with a

12 growing athlete who needs protein-rich diets to

13 thrive, I thank the Committee for your work, your

14 steadfast commitment to developing 2020

15 recommendations based on sound nutrition science.

16 MS. BROWN: Thank you. That concludes

17 our oral public comments, and we’ll now move to

18 closing remarks.

19 CHAIR SCHNEEMAN: Great. Well, on

20 behalf of the Committee, thank you to everyone for,

21 first of all, preparing the comments, doing them in

22 a very timely manner, and thinking about the needs


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1 of the Committee.

2 We appreciate your being here, and we

3 appreciate the effort that you’ve made with those

4 comments.

5 I once again want to thank the staff at

6 the Children’s Nutrition Research Center, where

7 we’ve been hosted for the last two days, that we

8 really have enjoyed being here, and we’ve really

9 enjoyed the support from that staff.

10 Likewise, to the USDA and HHS staff, who

11 really support the work of this Committee but also

12 made sure that this meeting went forward in a very

13 efficient and productive way. So thank you to all

14 of you, to helping the Committee meet its goals,

15 meet its targets.

16 I would remind people that, in terms of

17 comments, the comment period is open until the

18 Committee finishes its work, but we would encourage

19 you to submit comments by February 7 to have the

20 greatest impact in terms of the work ahead of the

21 Committee right now.

22 And I would also remind folks -- I


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1 commented earlier, and I just remind you again that

2 the website often will have additional information

3 about the protocols, how we’re defining things

4 within those protocols, any modifications that

5 we’ve had to do, and as the Departments identify

6 areas where further information is needed under the

7 frequently-asked questions to help the public

8 understand the process that we’re using, that that

9 information is there. And either sign up to be on

10 the listserv for the Dietary Guidelines, but check

11 back on that website if you’re looking for

12 information, just to get what’s latest and what’s

13 current.

14 And with that, I thank my Committee

15 members for your diligence, your hard work, for

16 paying attention through two long days, and

17 actually a day of subcommittee meetings before

18 then.

19 And I’ll turn it back to Dr. Stoody.

20 DR. STOODY: Thank you. And yes, thank

21 you to members of the Committee for what has been

22 a very productive meeting. It really worked out


305

1 that this timing, I think, was the right time to

2 bring everybody together, so thanks for those

3 productive conversations in those subcommittee

4 meetings, and the public discussion as well.

5 I think, as Tim said, there was very nice

6 discussion over these two days. So thank you for

7 that. Thanks to the members of the public and the

8 public commenters, who joined us as well.

9 And if we can go to the slides? Kevin?

10 So just a little bit more in relation to

11 what Dr. Schneeman said, and that is a wrap for

12 meeting four. And definitely thank you to the

13 Children’s Nutrition Research Center for all of

14 their support throughout this meeting.

15 In case -- if you would like to refer

16 back to information from this meeting, we will post,

17 as we always do, the recordings from this meeting,

18 as well as the presentations, minutes, and

19 transcripts.

20 And we’ll get that information up as

21 quickly as possible, and we will send a notification

22 out through our listserv. If you sign up for our


306

1 listserv, we’ll be sure to notify you when that

2 information is available.

3 In case you missed it yesterday, we did

4 announce that the Committee will hold a meeting on

5 its report, and this is the first time we’ve done

6 this, where it will be a meeting really devoted to

7 the Committee fine-tuning and discussing their

8 report before they submit to the Departments by the

9 end of May.

10 So that meeting will occur on Monday,

11 May 11. It will be webinar only, and we’ll provide

12 more information about that as we get closer.

13 So as Barbara mentioned, we do try to

14 keep our website up to date, and if you’re

15 interesting in signing up for our listserv, go to

16 DietaryGuidelines.gov.

17 At the bottom of the page, there is a

18 link that says "Stay Updated." You click on that,

19 you can sign up for the listserv.

20 As Barbara did too, of course, in

21 addition to thanks to the Committee members, we do

22 like to take a minute to thank the many staff who


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1 are involved in this process. And these are

2 individuals who support the nutrition evidence

3 systematic reviews. They support the data

4 analysis with staff from across USDA and HHS;

5 additionally, the food pattern modeling analyses.

6 These individuals help process the

7 about 17,775 public comments that we’ve received to

8 date. They help support the keeping transparency

9 at front of mind with updating

10 DietaryGuidelines.gov.

11 There are just so many elements, and one

12 of the things that we rarely do is public meetings,

13 and everybody kind of develops new skills to make

14 it happen. So thank you for that.

15 I do want to note, as we’ve said, this

16 was -- we have not had a meeting like this outside

17 of the D.C. area in 25 years, and we contacted our

18 ARS affiliates in a couple of different locations.

19 Houston was just awesome. They

20 were -- just the staff was -- sent us pictures. I

21 mean, it’s like we’d never been here, but it’s like

22 we had. So they thought of every single detail.


308

1 And there are two staff members in

2 particular that we would like to recognize, and they

3 are Perry Rainosek and Adam Gillum, and if you’ll

4 come down here very quickly?

5 (Applause.)

6 DR. STOODY: We have certificates of

7 appreciation to both of them, signed by Under

8 Secretary Lipps, on behalf of FNCS, for your support

9 of making this meeting a success and your really

10 huge attention to detail.

11 So thank you.

12 (Applause.)

13 DR. STOODY: Yeah. Thank you. So

14 with that, that’s a wrap. And with that, we’ll

15 adjourn for today, and we look forward to seeing you

16 at our next meeting in March, in Washington, D.C.

17 Thank you.

18 (Whereupon, at 3:57 p.m., the meeting

19 was adjourned.)

20

21

22



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Aa.m 1:9 5:2AAP 139:14ABA 162:2,5,11,14,19

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253:6 270:1affect 125:8affiliate 218:5affiliates 307:18affirmation 41:17 42:8affordability 124:2

169:3 292:22affordable 291:21afraid 68:6 109:12African 200:21 213:20afternoon 10:2 17:21

18:3 137:2,7 142:14145:16 158:8 161:22166:3 169:14 172:20176:8 183:2 186:5192:21 199:17 202:15206:7,10 215:12218:2 221:4 227:1253:5 261:13 264:8266:12 296:18 299:16300:1

age 80:1 101:2,15 110:2110:3 128:6 139:22153:9 154:17 155:7157:8 160:17 177:1181:2,3,14 197:20,22203:22 204:11 241:14


310

267:3 297:20 298:3300:14

age-related 157:12,14aged 298:11agency’s 179:15agenda 19:7ages 34:18 153:19

154:14,16 180:9254:22

aging 153:4,6 156:11181:7,19

ago 123:8 124:15189:22 207:17 210:7227:21 238:19 244:10244:11 264:11 265:13275:5 282:7

agree 111:8 117:21135:17 139:14 195:21226:15 276:12

agreeable 68:17agreed 10:15agreement 131:16agrees 149:21agricultural 1:8 7:10

145:20agriculture 234:14

235:11 289:8 292:14AHA 250:11,16,22ahead 303:20Al 296:18alarming 236:10alarmingly 206:3ALBERT 3:3alcohol 146:6,14,16,17

146:18 147:1,5,6,10147:12,13,15,19148:2,12 175:21

alcoholic 28:21 33:22ALI 3:1 281:10align 35:22 289:10alike 253:13alive 242:20 265:15all-cause 21:4,13 24:9

24:16 25:15 26:1927:2,22 28:13 29:1029:18,22 30:12 33:934:11,17 43:18 46:348:13,19 54:15 58:362:1 64:1 76:18,2177:4 114:18 134:10219:21 237:3

allergies 213:22 214:5Alliance 162:19 299:4Allie 2:5 166:5allies 237:16allow 88:14,17 141:7

150:19 230:1 268:3277:5 291:1

allowance 153:18allowed 1:9allowing 7:6 8:7 206:9

276:18allows 24:1 271:11

279:4alluded 59:12alongside 236:3alternate 137:22alternative 139:18

140:20 177:12alters 151:17altogether 229:6Alzheimer’s 52:9amazing 266:19ambiguous 84:10ambitious 162:16AMDR 23:15,18 24:4

31:22 32:6,7,10,2234:13 44:14 47:1956:1 61:11 157:7188:16

AMDRs 158:3America 118:22 139:3,4

172:22 197:19 199:13199:19 272:10

America’s 301:21American 7:4 8:8

109:22 110:17 139:11142:16 158:15 162:2162:12 179:18 180:1186:12 192:9 195:17196:17 198:4 200:8221:15 222:7,7 223:6223:15 225:7 226:13233:15 244:19 248:16249:9 250:6 253:21254:10,21,21 271:9,9

Americans 31:4 121:21123:18 130:4 150:14153:2 156:12 162:13170:3 178:17,20179:1,5 181:21 183:9189:6 193:15,22199:10 200:22,22205:17 207:6 209:8209:10 213:18,20218:19 220:15 225:18235:8 245:11 247:3249:20 255:13,16257:12 258:14,19262:5 265:7 266:9267:18 269:5 272:18274:5 286:22 289:1,3290:11 299:11,19300:8,13 301:16302:3

amid 170:21

amino 161:8amount 10:19 29:1 34:2

42:9 59:22,22 109:1156:17 157:4 185:15194:10 226:1 262:16262:21 272:22 277:5291:12 301:3

amounts 66:22 173:10174:11,16 184:8193:6 196:21 247:5253:22

Amy 2:15 227:2analyses 43:17 44:4

56:21 62:21 73:2176:8,9 89:14 108:4307:5

analysis 14:10 15:2117:9 26:22 27:5,11,1127:12 30:14 60:1385:17 89:1,2 91:195:19 97:1 101:11,17114:7 203:7 247:9284:16 307:4

analyst 169:15analysts 25:18analytic 24:12,13 44:7

46:9,13,19 47:7analytical 42:19 43:12

73:14 76:20 78:4 83:2240:11

analyze 232:15analyzed 99:18analyzing 205:15anaphylactic 214:10ancestor 283:10anchor 115:2and/or 23:13 24:20,22

25:1,5 27:5 28:15180:10

anencephaly 178:22animal 28:16 33:17

185:13 196:20 197:11197:16,16 199:10210:8 212:5 234:11235:6,11 236:13238:6 245:5 246:8,12257:10 275:16 281:17283:11

animal-based 170:18217:17 258:20

animal-derived 257:19animals 213:3,10 242:4Ann 231:1announce 221:1 306:4announced 217:5annual 263:7annually 263:4answer 9:15 23:22

24:10 86:7 94:2 97:14101:10 116:5,14,21117:13 138:11 227:12239:7

answered 72:18answering 64:7 89:3answers 182:2Anthony 2:22 273:12antioxidant 292:6Antonio 200:15anxiety 52:12anybody 20:7 113:21

113:22anymore 267:12anyway 43:2 69:22apart 125:11ape 283:9apparently 22:7appealing 209:2appear 156:11 270:3appears 135:8appetite 267:4appetizer 260:10applaud 193:9 268:10

284:9applauded 225:2applauds 297:1applause 11:1,3 13:8,9

13:16 37:4 89:19308:5,12

apple 288:5 289:14applicable 146:9application 291:17applied 27:17 33:1applying 282:10appreciate 13:5 14:1

132:19 134:4 135:21137:10 138:8 172:22176:3 212:7 255:20271:16 290:9 303:2,3

appreciated 122:10appreciates 180:4appreciation 11:12

13:19 308:7approach 17:5 20:1

24:1,10,15 27:16121:8 123:6 126:12127:7 131:7,20135:10,15 153:7163:11 193:10 274:7287:21

approaches 17:1826:20 29:12

appropriate 111:8178:19 185:2 193:2194:17 247:5

appropriate-sized271:6


311

approved 230:2approximately 14:8

21:2Arbor 231:1Ard 1:12 19:11,11,17

54:13,13 66:8,8 106:5114:14,14

area 8:13 20:18 70:1790:17 93:8 119:21126:22 131:2,15132:20 218:8 221:12287:8 307:17

areas 16:3 128:14129:19 237:1 278:9304:6

aren’t 62:3 64:1 108:16121:3 130:4 301:15302:1

arguments 254:4Arizona 266:21aroma 279:6array 270:18ARS 6:9 13:20 307:18arsenic 179:10,14art 283:11arteries 258:4arthritis 210:14 214:5article 47:16articles 20:22 21:2,10

22:17 25:14,20,2226:1,2,4,6,9,11,11,2127:3,6,9,10,14,1530:5 35:17 47:2072:16 113:19 205:15246:13

artificial 150:5 176:14ascertain 194:18

294:14Asians 213:20aside 26:12asked 9:15 17:4 76:16

92:11 116:7 129:11asking 294:12ASN 180:1,6aspect 95:3 109:18

265:9aspects 19:1 103:21assembling 183:8assess 26:20 30:15,17

80:19 83:16 85:8 94:698:15 194:1

assessed 21:9 78:2287:14 94:17 101:3220:2

assessing 95:3 220:4assessment 36:3 88:14

94:21 98:13,17107:17 115:16 178:14

188:9 262:15assessments 98:1

165:7assignable 77:5assist 164:13assistance 5:15 121:9

194:6assistant 250:8associate 176:9associated 28:12 29:21

33:9 93:10 140:8144:8 170:19 175:7175:19 176:1 179:10184:18 185:8 201:3204:6 247:11 249:6251:17 252:7 263:9271:14 295:21 296:2

association 79:8 81:781:10,13,14,17,2284:1,6 85:22 100:21101:21 106:8 142:16145:18 149:4 152:12162:2,3 192:10 201:7201:8 223:7 226:14233:15 246:20,21250:7 253:7 254:22257:16 270:2,5 271:9296:20 300:18

associations 28:1733:17 187:21 223:9

assume 62:1 189:15asthma 197:6 214:5,8

214:14,16at-scale 292:20ate 105:8 227:5 283:10athlete 300:5 302:12Atkins 186:7attack 215:20attacks 197:18 294:3attainable 185:1attempt 74:13attention 63:5 173:17

212:8 239:4,4 241:3304:16 308:10

attest 210:20attorney 215:14attributed 207:4attrition 82:11 84:16

86:8 87:19AUDIENCE 5:22auditorium 138:15,16August 164:11 165:17

248:7Austin 196:15 238:14

264:10 273:14 293:15authorities 271:8Authority 164:18authors 174:1,7,18

autism 52:13availability 132:11

291:7available 15:14 22:3

34:16 47:14 62:9 77:278:8 79:12,19,21 80:582:18 84:18 86:1091:19 116:15 138:2138:18 145:2 160:19177:5 229:18 291:21292:6 306:2

average 109:22 172:1235:9 242:6,9,13,16272:22

averages 175:2avoid 140:16 141:11

147:12 177:18 190:5197:3

avoided 225:19Avoiding 279:22aware 111:6 229:3awareness 152:17

289:6awesome 307:19

BB 143:16 184:2 219:5

302:4B-24 53:10 62:6 127:21

140:5 180:9,11,13B12 184:10 185:22B6 167:20 185:18

247:19babies 142:2 279:19

281:2baby 134:16,17 141:8

184:12 213:6 242:14242:16 263:2 277:19278:2 279:4 280:15280:22

baby’s 184:8 262:17,20280:1

back 6:11 57:11 64:968:15,17 96:20 97:18105:20 112:17,22118:2 133:1,5 134:6136:9,19,20 189:22190:15 234:5 301:7304:11,19 305:16

back-of-the 76:12background 5:12 7:7

71:5backgrounds 193:17Backus 2:4 158:8,9backwards 195:3bacon 160:13 221:20

222:4bad 66:10,10 67:7

125:7 197:9 294:19BAILEY 1:13 89:22

90:14 101:4 129:20bakery 159:14balance 126:2 161:7

162:12 178:4 180:14270:16

balanced 149:19158:17 161:16 163:3185:11 226:8 241:14271:12,18

ball 124:21ban 280:21banana 288:5bananas 294:19Bandana 2:14 221:5banning 275:5bar 87:2Barbara 1:9,11 4:5,11

13:13 306:13,20barely 61:10,11barriers 259:13 261:5bars 121:12base 132:14 159:13based 23:1,6,10 27:1,5

27:7 36:11 43:1046:12 47:21 48:2,367:21 93:6 97:17 98:8108:11 109:21 124:14124:18 132:10 140:10142:5 145:1 153:17156:17 157:19 165:13166:22 168:20 172:11173:21 188:6 190:21190:22 211:17,18254:13 262:14 267:16267:21 269:15 290:13302:15

baseline 78:15,19,2183:17 84:2,7 87:1498:15,19,21 102:8,14102:15,19 103:4,6,7103:12

basic 117:6 205:22basically 40:19 41:2

45:17 215:22 216:12285:3 288:4 294:20

basing 180:13basis 13:3 124:15

170:10 194:16 243:22282:12 283:2

Bates 1:8Baylor 7:11 8:5 281:12BAZZANO 1:13 44:11

46:2,5 60:19 61:1768:9

beans 142:21 143:3,6143:10 145:6 168:4


312

197:9,12 296:13bearing 193:4beautiful 293:18beauty 123:12Becky 2:2 142:15becoming 109:15

281:21beef 158:16 160:12

198:18 300:8,9,15,18300:18,22 301:1,4,7301:22,22 302:6

beer 145:17,19,21146:2 147:17 148:5

began 15:4 197:7 282:8beginning 10:4 15:10

16:2 19:22 74:6 75:1982:13 127:8,15 157:9183:13 198:9 221:3262:7 273:10

begins 126:19 127:15157:11 205:13

behalf 6:6 13:18 139:3142:15 166:5 176:20180:1 183:4 186:7202:19 218:4 220:17234:10 238:17 244:7266:14 302:7,20308:8

behavior 70:4,6,15104:11 130:7 196:7293:3

behaviors 195:2 205:19behold 190:13beings 243:6beliefs 140:1believe 50:1 53:8

122:16 123:3 146:3166:22 173:5 244:18245:8 273:4 278:19280:1 290:5

believed 185:9believes 146:22 147:17beloved 242:5beltway 6:20 7:2beneficial 56:4,5 59:3

174:13 247:4 249:17261:20

benefit 63:18 184:6223:5 240:20 274:4,6301:16 302:3

benefits 63:10,16 66:5140:12 143:22 144:3144:12 145:9 146:6158:19,22 159:9166:18 168:11 169:4169:6 174:7 177:22200:10 201:19 202:4205:17 229:17 236:22

249:6,10 253:18254:2 264:3,4 281:2299:12

Berit 2:3 152:9beseech 211:14best 42:2 105:18 123:5

141:8 156:14 174:6177:5 190:21 196:22213:1 250:13 257:3260:22 275:18

Beth 118:9better 51:21 127:2,16

146:22 149:22 158:12195:8 211:9 212:3231:12 253:18 262:19268:8 289:15 295:8301:11

between-subject 76:9beverage 15:9 75:6,6

122:18 146:6 162:2,4162:21 163:6 164:3,8165:7,12 173:8 175:1175:6,10,13,18180:16 249:15

beverages 15:20 22:1528:3,21 33:22 36:1340:11 41:1,1 57:274:22,22 87:18122:15,19 147:5,7,10147:14,15,16,19149:6 163:2,4,5,18,19164:5,12,21 165:1,21173:1,3,12,19 174:2,3174:19 175:21 213:2250:21 255:1 263:13271:3 297:4 299:14

beyond 122:19bias 21:9 36:3 82:10

84:15 86:6Bier 8:4bifida 178:21big 12:21 37:13 38:21

59:17 85:15 107:21114:17 117:13 296:15296:15

bigger 81:15 283:9biggest 259:13Bill 2:2 145:16billion 202:2 216:22

217:6 263:17 288:3bioactive 175:7 219:12

220:16 249:3bioactives 218:14

248:16,18 249:18,21250:1

bioavailability 156:8292:3

bioavailable 184:11

biological 58:2 126:18128:7 213:5

biostatistician 119:18biostatisticians 119:17birth 15:19 25:8 180:9

242:15 277:15 278:14297:18

bit 15:4 38:11 39:8,949:5 95:2,10,16 117:2123:8,17 124:5136:16 260:11 293:16305:10

bite 280:1bites 118:5 279:10black 143:10blatant 65:21bloating 231:10blood 83:6,20,21 84:2

115:12 144:6 164:19190:7 197:5 198:12198:14 201:5 209:20218:21,22 220:5,6229:5 231:13,14265:2,22 266:1282:18,18,21 283:19283:20 288:17

Blue 232:22BMI 81:4,4 106:16,18

106:19 176:2board 31:5 183:4

196:17 217:7board-certified 208:20

209:14 221:9 224:3293:13

bodies 139:15 229:9bodily 297:8body 9:14 21:6 25:10

32:1 34:14 36:7 39:1863:9 77:9,18 79:1780:1 81:4,9,11,15,1882:1,20 91:14 93:1295:9 101:21 106:11114:19 125:8 128:2133:22 156:18 157:1171:13 172:12 184:4188:11 205:8 227:21245:19 248:1,1,12266:4 275:12 276:3297:14

boils 71:20bold 212:17bonds 276:1bone 21:17 35:19 49:7

52:1,3 131:21 184:16253:18

boost 262:20 289:6Boston 48:11 130:13bottled 296:20,21

bottom 77:15 306:17bound 157:7boundaries 238:9Boushey 1:14 4:8 20:11

20:13 37:5,17 38:4,638:9 39:1,12,19 41:1344:9 45:4,7,11,16,2045:22 46:14 47:1148:17 49:12 50:1951:2,8,13,19 52:20,2253:3,8 54:3 59:1461:16,20 62:11 63:20105:14 122:9 261:7

brain 191:11,11 261:21265:21 283:9

brains 184:3brand-new 260:9Brandon 4:4 5:10brands 280:17bread 294:7break 48:14 68:15 69:1

69:3 107:2 120:20136:8 221:2 226:22230:12

breakfast 71:8,11 91:792:4 183:21 194:15

breakfast-skipping90:21

breaking 133:1breaks 18:2 279:10breakthrough 265:12breast 51:10 139:12

140:20 141:6 197:20208:2 213:9 222:18275:17 297:22

breastfed 139:19141:10

breastfeeding 79:5,6140:12

breathe 214:12Brenna 2:16 238:12,12brewers 145:19brief 70:2 71:5 221:2

270:9 298:10briefly 72:22brightest 290:2bring 173:17 175:2

239:3,4 241:21 305:2brings 290:2broad 79:22 143:2broader 129:18 146:7

151:21broadly 40:11 129:8

171:19Brooke 2:12 209:14brother 202:6brought 7:14,20 14:13

42:19 95:1 127:21


313

174:10BROWN 138:22 142:12

145:14 148:22 152:7155:12 158:6 161:20166:1 169:11 172:18176:6 179:20 182:22186:3 189:9 192:14196:11 199:15 202:9202:12 206:5 209:11212:9 215:8,10217:22 220:22 223:18223:21 226:20 230:11230:16 234:7 238:1,4238:7,10 241:5 244:1244:3 246:16 250:3252:21 253:3 256:3259:1 261:11 264:6266:10 269:19 273:5273:8 277:11 281:3,6283:22 287:4 289:18293:4,7,9 296:16299:20 302:16

brushing 203:14205:20

budget 217:3,3,6budgetary 291:3build 110:14building 115:3 277:17built 182:2bullet 39:21 95:15 96:4

301:15burgers 225:21 261:9Burnet 294:15business 289:8businesswoman 300:4busy 10:12butter 294:8buy 259:12

CC 167:20 247:19C-reactive 258:2cafeteria 259:22caffeinated 165:7caffeine 165:4,8,11cage-free 198:20cakes 226:3calcium 151:19 201:16

214:19,21 247:18253:17

calculation 76:9calculations 76:12calf 242:14call 4:2 66:3 90:4

100:13 118:4 138:9259:9 277:8

called 71:20 99:16115:19 138:10 236:12

236:14 265:11calling 133:6caloric 297:15calorie 63:2 149:2,3

162:18 165:14 176:17257:2 270:12 272:1

calorie-dense 283:11calorie-restricting

267:2calories 57:16 99:21

121:4 148:12 149:20151:3 157:2,6,20162:21 164:1 170:18185:15 208:15,16216:10,12 225:11227:11,11 228:6229:11,16 233:20252:3 259:17 272:19274:3 283:7 284:14297:14,16 301:9

campaigns 295:10can’t 31:16 91:10 103:4

105:22Canada 212:16 237:17

241:9 243:16cancelled 252:22cancer 21:17 35:18

49:6 50:1,1,6 51:11197:17 198:22 207:19208:2 221:21 222:3,5222:6,7,9,10,10,13,14222:14,18 237:3258:5,11 271:9288:19 296:3

cancers 49:19 50:1751:7 144:10 288:14

candidate 215:17candies 167:5candy 271:13,17

272:14,18,22candymakers 270:6cane 121:16canned 292:7capita 199:11caps 268:14capture 74:14 98:12,18

123:9 135:20 143:9captured 101:7 261:22capturing 103:18carb 229:16 274:3

282:10 284:2,5 285:5carbohydrate 23:12,18

32:5 44:14 61:3 66:1667:6 121:4 126:3,4167:1,11 188:21216:13 246:2 257:17284:3 285:9

carbohydrates 29:2,9

34:3,10 56:3 60:367:14 167:15 168:3188:14,22 189:3197:8 213:12 229:11233:21 245:3 250:20251:19,20 256:18257:19 258:9 274:1285:3

carbon 276:1carbs 148:12 197:10

274:17 283:7 284:15285:12 286:17 294:19301:12

carcinogenic 222:3cardiac 190:14 192:5cardiologist 281:11cardiometabolic 144:6cardiovascular 21:7

36:9 77:10,19 83:2,384:20 115:14 144:5174:9 185:8 200:20201:4 206:21 207:13208:8 218:18 219:19219:22,22 220:7221:22 222:21 228:9237:2 246:9 249:8252:8 253:19 257:13258:4,5 295:21

care 141:4 148:3152:19 187:22 194:12198:5 199:5,12 202:2202:8 204:17 207:2,5209:8 217:3 261:18267:17 268:4 281:13288:4 289:13 296:4

career 8:21careers 9:4,7careful 67:3 111:12

117:12,18caregivers 139:22

140:11,19 141:3179:15 180:13

caries 203:18 204:3,20205:1,7

Carnegie 210:2Carney 2:10 196:13,13carnivorous 215:16,22

217:14Carol 1:14 4:8 20:13

49:2 59:6,12 69:12carotenoids 248:18carried 204:15carry 36:1 51:17,22cars 294:1Cary 2:19 253:5cascade 276:3case 18:9 43:1 47:15

97:19 100:15 102:18

267:15 305:15 306:3cases 154:5 235:8

279:1 285:22cast 242:21cat 214:10catapult 235:11catastrophic 235:13catch 210:22categories 33:2 39:16

168:13,16 175:14285:12

categorization 165:12167:13 168:20

category 62:22 75:679:20 167:5 270:11

category’s 145:9cats 214:16cattle 302:7cattle-raising 300:21Cattlemen’s 300:17causation 191:3cause 48:14 232:2

250:14 264:18caused 209:20 214:5causes 24:17 206:19

207:1,3causing 214:8caution 268:8cautioned 148:1CCC 149:9,21 150:6,15CDC 164:1 271:10

297:21celebrations 271:15cell 105:7,11 275:14cells 265:21,22cement 254:17center 1:8 5:7 7:6,16

8:4,12 13:20,21 159:1160:21 176:10 231:1256:13 298:9 303:6305:13

Centers 297:9Central 17:22 18:6

230:13cereal 159:13 179:2,9

179:17cereals 151:22 179:12

280:3certain 33:8 40:3,22

66:10 120:7,8 144:9152:4 264:3 288:14

certainly 48:19 59:462:19 109:19 129:14219:8 232:19 262:19

certificates 308:6certified 243:1cetera 44:20chain 176:17


314

chair 1:9,11,12 4:5,1113:12,17 19:16,20,2120:5 42:14 46:17 48:953:13 60:18 64:8 66:668:14,20 69:6 89:2093:17 103:16 105:4106:3,20,22 108:1109:4 125:14 134:3135:17 278:14 302:19

challenge 171:21challenges 8:2 40:15

106:9 119:20 132:22196:4 290:5

challenging 103:20,20119:15 195:18

chance 12:17change 63:17 78:15,20

79:2,9 81:4,4 101:22103:1 110:9 130:12132:15 134:7 194:8195:20 196:7 201:21236:11 295:11

changed 104:15 190:11210:7 267:1

changes 55:8 63:9,14131:22 132:3 156:9163:11 285:18 296:15

changing 90:15 122:14205:18 295:3

channels 235:18Char 4:12characteristics 165:13characterization

188:18characterized 28:2

33:12 66:16 157:12charge 94:11 233:3chasing 210:21Chawla 2:14,14 221:4,5

223:19 224:1,2check 17:15 19:8 20:6

304:10Check-off 300:18Checkoff 158:16checkup 287:18cheese 125:6 201:11

245:15cheeses 215:7 254:8chemical-rich 276:20chemicals 276:8chemistry 238:15chemokines 219:4chemotherapy 209:21chew 204:20 279:5chewing 203:1 204:22

205:9Chicago 202:18chickpeas 143:6,11

chief 210:3chiefly 235:7child 135:13 194:8,12

239:15childhood 50:22 52:13

62:1 93:18 127:13204:11 224:13 239:9275:21 277:14 280:9

children 7:16 25:4 62:281:21 100:20 101:2129:13 139:6 154:15154:16 167:22 177:1177:17 179:9 183:19187:9 193:14 194:20194:22 196:15 199:4199:7 203:22 204:20210:11 235:22 237:14248:6,8,13 252:2,8253:13,21 254:22277:22 288:21 297:18298:1 300:12

Children’s 1:8 7:5,158:3 13:20 287:8 303:6305:13

chocolate 125:9 270:6271:13,17 272:14

choice 92:7 108:19141:8 163:17 167:7235:1 301:18

choices 58:8 121:3,10122:3 129:22 155:17155:21 156:4,7,16157:16 175:10,19189:17 226:7 243:11

cholesterol 144:7 190:8225:4 228:11 257:5257:11 268:7 275:2277:3,10 282:1,19283:20 288:12,18

cholesterols 198:10choline 143:17 302:5choose 108:11 178:5,6

278:20choosing 121:13 251:6Chris 2:8 183:2 189:11CHRISTOPHER 2:9chronic 25:6 115:21,21

130:9 162:10 170:6188:1,5 193:16203:10,19 206:13224:11 234:16 236:6248:17 252:13 269:6274:6 285:20 286:1294:2 297:19

chronically 227:8Cipro 231:22circle 112:22circular 124:13

circumference 81:5citizens 224:7City 212:13civilized 243:17claims 161:4 254:11,12clarification 42:18

102:7 104:10 111:15clarified 73:20clarify 17:5 23:5 43:13

44:3 45:1 47:5 217:16clarity 195:22class 244:11classification 168:14classified 166:18classifying 222:3classrooms 237:8clean-burning 265:20clear 17:11,22 30:19

35:1 40:13 59:5,10104:3 109:21 110:7110:10 146:12 173:6178:5 187:20 190:19193:1 199:1,9 202:7212:1 223:12 225:3225:19,19 226:6258:13,19 295:5,6,13296:6

clear-cut 222:9cleared 139:17 140:21clearer 295:7clearly 71:9 126:22

188:3 197:15 227:18299:12

click 306:18climate 235:16 236:4

236:11 237:6clinical 116:20 118:1

173:16,22 220:11233:16 249:10 268:15269:15 273:16 283:18284:8 285:8,22286:14,15

clinician 273:14clinicians 231:2 299:9Clinthorne 2:8 186:5,6close 11:19 141:18

151:16 223:9 284:15closely 15:6 171:10closer 55:4 135:14,15

306:12closest 283:9closing 145:5 168:21

299:21 302:18clots 209:20clouding 159:3cluster 27:5clusters 57:3CNPP 12:20

co-founder 277:13coach 264:9Coalition 266:15coauthors 238:18Cochrane 220:4 267:22codes 148:16coffee 248:22cognitive 52:9 168:1cohort 26:12 30:4 37:9

79:7 80:7 83:10 85:587:14 219:17 257:14295:17

coincide 134:21coincidentally 275:9cold-pressed 277:19collaborate 89:1collaborative 64:20colleague 6:8colleagues 8:4 12:13

12:14 171:7 210:20collection 74:1 75:10collections 98:9collective 141:22 283:3collectively 274:10College 7:11 8:5 202:18

204:16 212:13 281:12colon 207:19 288:19color 236:2 279:6colorectal 51:11 221:21

222:2,10 237:3colors 279:19Columbia 212:15combat 237:8combination 22:2combinations 28:2

57:17combined 7:22 21:4

156:9come 10:14 15:7 57:10

59:12 60:8 62:12 64:867:9 68:15 117:11122:10 129:2 134:6136:5,9 198:10220:19 234:5 240:14274:16 276:6 282:11283:14 284:15 288:20308:4

comes 60:6 61:5 72:174:4 112:21 222:11294:6

comfortable 19:22 20:3coming 34:20 50:11

58:12 88:2 107:14108:4 114:7 117:17117:19 118:4 188:14283:7

comment 6:22 14:2018:8 19:5 20:7 37:10


315

38:7,10 41:14,1846:18 54:8,11 61:2266:14 92:2 98:6111:14 116:18 123:17126:14 127:20 128:18137:6 138:20 145:13152:11 166:4 175:17176:16 218:3 220:20244:1 281:6 293:7299:5 303:17

commented 37:7 304:1commenter 139:1

142:13 145:15 149:1152:7 155:12 158:7161:21 166:2 169:12172:19 176:7 179:20186:4 189:10 192:15196:12 199:16 202:12202:13 206:5 209:12212:10 215:11 218:1223:21 226:21 230:13230:18 234:7 238:11238:11 241:6 246:17250:4 252:22 253:4256:3,5 259:2 261:12264:6 266:11 269:20277:11 281:9 283:22287:5 289:18 293:10296:17 299:21

commenters 2:1 273:9305:8

comments 4:13 6:1810:3,8 11:16,17 12:113:18 16:11,12 18:518:15,22,22 19:922:19,21 43:4 47:648:16 53:15 64:1466:6 69:4,19 105:5127:5 132:19 135:18136:9 137:9,13,15,16138:7 142:10,11148:19 152:2 155:10169:10 176:4 177:2178:7 186:2 202:20206:4,9 218:11 221:1239:1 240:4,5 244:9255:21 256:1,15270:9 299:16 302:17302:21 303:4,17,19307:7

commercial 262:15commercially 280:18

281:4commitment 148:6

272:9 302:14committed 152:16

165:19 250:11 272:1committee 1:1,7 4:11

5:5 6:5,18 7:3 8:7,189:2,8,22 10:9,11,2211:12,18,19 12:3,6,1612:18 13:4,13,19 14:614:13,17 15:15,2216:2,9,14,20,22 17:617:11 18:20 19:2,5,820:17,20 22:21 23:224:1 33:3 35:21 38:1240:9 41:9 54:6 64:2169:8,11 72:18 89:1589:16 105:20 107:1109:13 110:6 116:16120:4 121:20 126:20135:21 138:12 142:17142:19 143:11,21145:2,5,8 148:20149:15 150:3,9,12152:22 155:5,20157:21,22 162:6,7163:16 165:10 167:12168:4,18 169:5,19170:7,13 171:2,5,12171:20 172:11,14,22177:16,20 179:7180:16,21 181:4183:7 189:5 191:3195:11 202:21 209:6213:7 215:1 217:21220:17 221:16 223:13237:21 238:22 240:15243:20 244:19 245:8250:10 251:8,22252:10,17 254:9255:11,18,22 256:9258:12,18 268:17276:13 277:15 278:10278:15 280:7 284:10287:12 289:6 290:14292:14 297:5 298:3299:6,17,18 302:13302:20 303:1,11,14303:18,21 304:14,21306:4,7,21

committee’s 11:8 90:15118:15 132:19 165:15172:16 235:14

committees 15:11 41:758:20 107:15,18,20129:9

commodities 243:4common 29:13 31:19

121:17 159:7 160:11179:5 203:19 287:14

commonalities 133:22commonly 87:20

174:17commonplace 243:1

communicate 140:15141:2

communicating 149:11communication 41:12

133:4,16 261:15communications

246:19communities 236:2community 116:12

118:22 200:17 206:2217:2 221:8,15228:17 289:16

companies 139:5141:21 162:15 165:19

company 148:16277:14

comparators 24:21compare 245:21compared 32:17 43:16

85:13 95:21 99:19168:3 204:21 205:2248:4

comparing 171:22286:15

comparison 27:1332:11 80:11 83:13275:22

comparisons 44:746:12 87:15 95:2297:10

compass 196:1Compassion 234:10compel 289:8compensate 260:4compensation 91:5compiled 178:7complement 121:7

155:6complementary 141:16

183:15 279:19complemented 120:22complementing 154:19complete 36:2 69:15

177:2completed 89:13

172:14 178:14completely 37:18 45:9

196:20 197:12 243:10complex 40:16 122:21

197:8 258:8complications 294:4complimenting 231:15component 22:22

161:15 165:5components 31:11,19

36:12 44:17 65:7,15133:7 170:4 175:7292:4,10

composition 21:6 36:743:16 44:1 77:9,1879:17 81:9,11,16,1882:1,20 93:4 95:9106:11 114:5

compound 213:5compounds 174:11

213:22 220:16 249:17276:4

comprehensive 277:20comprised 29:20comprising 32:13

299:7concept 45:9 93:1

115:4 134:4 284:3conception 181:1conceptual 36:10conceptualize 59:11concern 68:4 131:12

143:20 148:1,2150:11 151:4 166:13201:14 204:5 215:5235:14 247:20 274:20288:21 289:5

concerned 95:2 153:11169:16 171:7 215:18

concerning 274:14concerns 284:12 292:9conclude 79:11 110:14

138:7,19 167:6263:19

concluded 84:17 86:9241:12

concludes 19:6 302:16conclusion 19:1 21:12

54:17 57:11 65:13,2278:9 82:16 171:2,21189:4

conclusions 14:7,11,1586:19 91:11 110:12117:11 240:14,18

concrete 131:19condense 42:2condition 216:3 265:11conditions 152:4

193:16 203:19 214:4conduct 9:17 203:8conducted 118:20,21

139:20 205:6 260:9confectionary 272:4,20Confectioners 270:2confections 272:16conference 20:4,10confess 121:18confidence 274:9confirm 247:7 253:1confirmed 202:8conflict 199:1


316

conflicting 256:20conflicts 239:18 266:17confounder 100:13confounders 15:8 25:9

30:6 88:19 165:14confounding 102:19confused 67:5 95:16

209:1 254:12confusing 66:19 145:6confusion 142:20 159:4congestive 227:16congregate 194:13connect 200:9connection 271:21consequences 184:19

235:1,13 241:20consider 23:5 87:2

142:4 149:15 151:14152:22 153:13 165:10167:14 177:21 245:8251:22 252:18 255:22280:15

considerable 38:22consideration 88:18,20

112:3 118:15 152:2161:18 165:5 169:8172:16 217:21 234:20298:4,7

considerations 178:4183:10

considered 14:17 31:12104:11 109:11 135:8174:3 187:4,16244:18 247:20 249:14

considering 23:1053:18 56:15 154:22174:20 188:13 268:10

considers 155:5consistency 27:19

28:14 37:8 39:1154:20 58:14 59:760:13 65:10

consistent 29:3 32:234:4 39:22 54:1755:15 56:8,10,18 57:557:7 59:4 65:6,2066:18 67:13 81:2088:6 93:13 103:13127:17 177:15 189:1210:18 220:12 297:21301:4

consistently 107:14115:7 130:1 282:17299:12

consisting 201:22207:9 286:17

constantly 122:14264:15,16 265:2

283:4constipation 287:13,17

288:3,19consult 148:3consume 57:16 147:1

147:10 151:7 177:6179:2 194:20 204:7208:4 213:8 214:6222:19 245:2 247:22249:20 255:1 271:6

consumed 22:5 24:927:21 110:16 120:12139:9 146:2,15162:21 166:17 173:11174:17 222:5 275:6279:18

consumer 5:10,13 6:7135:12,13 176:11178:5 270:18 292:21293:2,5 298:13

consumers 5:17 146:5148:11,17 158:20161:1,6,11 163:3164:13,20 175:9219:15 251:5 254:2254:10 259:9 261:4270:7,12 271:5,16,21272:1,7 291:1

consuming 55:10 57:2266:22 147:8,12,15148:2 151:21 157:18174:8 207:21 222:11243:21 253:22 255:7258:14

consumption 24:20,2125:1 28:6,18 29:633:19 34:7 54:22 59:287:6 88:10 130:19144:2 146:7 148:7159:15 164:3 167:14168:1,5 173:8 175:13175:20 176:1 178:1179:8 180:17,18193:7 207:18 219:18220:15 223:10 225:15225:21 226:3,4,16,17236:18 237:19 238:6239:9 243:15,15247:11,13 249:15252:9 257:6 259:13259:21 262:5 263:16263:20,22 297:22298:16 299:13

consumptions 236:13252:15

contacted 307:17contain 179:13 185:11

213:11 271:20

containing 168:7188:20 249:20

contains 146:17 214:17249:17

content 56:4 92:6,8147:6 148:12

contents 4:1 219:11,12context 32:12 36:14

40:16 56:10 57:1460:12,15 107:10110:21 129:18 146:7173:1 185:10 271:12277:17

continuation 146:12continue 11:8 12:3 17:1

58:19 118:16 157:21164:2 182:20 206:12235:10 249:13 253:20255:11 256:21 290:14299:17

continued 4:6 181:17182:8 268:13

continues 150:10 164:4183:7 204:4

continuing 9:12continuous 135:9continuum 296:6contractor 158:15contrary 199:4 257:7contrast 289:2contribute 41:7 88:4

132:13 163:20 246:3contributed 69:13

300:19contributes 262:17

279:7 301:2contributing 57:22

120:14 164:6contributor 222:2 225:6

263:16contributors 174:15

249:2control 80:6 97:16 99:5

100:5 149:3,3,12164:19 184:1 267:3270:15 271:7,10279:12 283:5

Control’s 297:10controlled 40:5 43:20

46:7 88:5 94:18,2099:2,12 173:22 191:1258:11 259:19 295:18

controls 204:21controversial 276:18controversy 170:22

254:15convene 230:12convenience 161:11

246:14 292:22convenient 161:7

278:21 291:21conversation 54:11

122:11 134:8 135:7conversations 23:1

114:16 305:3convert 241:1 302:8convey 133:14cooked 63:3 144:14

160:7cookies 226:3cooking 159:17 283:12cooperatives 253:9coordination 5:18

279:9corn 179:4Cornell 238:20coronary 83:19 84:8corporate 198:4correct 44:5 99:17

100:16 102:10 143:12150:6 157:16

correctly 102:7correlation 191:2correlational 190:22cost 124:1 202:2cost-effective 163:14costing 124:7costs 152:19 198:5

207:5 216:20 217:13263:8,16,18 288:4289:13

couldn’t 214:11 265:7council 139:3,4 149:3,3

152:10 155:1 166:6199:22

count 228:5counting 192:13countless 191:19

228:22 229:19 236:21countries 59:8 237:17

255:4 290:1 298:15country 31:7 189:14

216:16 229:7 230:9237:7 262:8 263:1293:14

counts 162:18county 244:6couple 114:14 118:10

118:14 119:8 130:14138:4 196:6 307:18

courage 238:2course 62:2 75:3,18

84:5 88:4 116:3,19126:12 127:6 131:7134:7,9 230:6 306:20

covariant 92:14 103:8


317

cover 47:10covered 49:4 52:7,11

52:15 79:22covers 75:22cow 199:5 242:14cow’s 200:7 253:15

255:1cows 213:6,10 214:18

242:10,17 243:4create 62:22 156:10

158:1 205:22 264:1created 22:10 41:21

265:11creates 57:12creating 235:20creepy 281:5crisis 207:2 236:5

237:11criteria 23:4,21 25:21

26:8 46:20 47:22,2248:7 72:13 73:15,2175:3,4,16 79:19 83:985:4 94:15,22 104:19105:1 111:19

critical 9:19 82:8 140:7146:10 152:5 193:3237:19 270:22 278:6279:9 280:5,19290:22 292:19 293:2299:2

crops 302:11cross-cutting 203:8crossroads 209:7crucial 184:3,8 225:12

253:14 291:16CSPI 176:20 177:20

178:7CSPI’s 177:1cultural 161:11 193:17

269:12 291:3,9culturally 178:19 185:2cultures 200:10cumin 260:11Cuomo 217:5cup 144:14 174:16

175:8cups 144:13,17,20

145:3,11cured 160:7curious 129:21 294:11current 9:14 140:1

141:14 156:18 158:2170:6,20 171:1 172:1172:12 173:6,9174:20 178:8,11187:8 200:6 203:9224:11,19 225:12,13232:6 234:17,21

243:13 247:2 251:1252:1,9 260:15 274:7274:18 275:11 277:2277:4 284:12 301:5304:13

currently 143:9 156:5194:3 206:18 207:2208:9 212:18 226:10262:17 286:5

customary 74:14cut 217:6,8 228:10

301:7cuts 161:10cutting 107:19 159:16cytokines 219:3

DD 141:11 201:15 247:18

253:17 292:9D.C 6:20 7:2 169:17

220:18 230:20 253:8266:14 307:17 308:16

daily 13:3 75:3 80:1981:2 83:16 85:8 151:4156:16 175:22 207:18209:4 214:6 222:5,12243:12 244:12 273:1283:2

dairy 29:1,7,8 34:2,8,955:11 125:5 163:20177:11 197:3 198:7198:21 199:2,8,14,18199:21,21,22 200:3,4200:11 201:2,3,9,14201:19 202:1 210:8210:16 211:8 212:2212:18,19,19,22213:2,14 214:6,7,13214:14,17,22 215:1,4215:6 224:21 225:7,8226:16 228:4 235:7241:9,12,18,21,22242:2,3,5,8,10,17243:2,4,14,15,18,21253:7,9,10,14 254:1254:11 255:4,8,8,11255:15,19 258:20299:1

dairy’s 254:17Dallas 244:7damage 276:5damaged 199:7 229:14dangerous 198:21Darren 2:15 230:20DASH 29:16 31:4,4,6

55:2,5 65:4 185:3data 14:10 15:21 17:8

21:9 36:3 39:10 50:7

54:15 56:9 62:2,5,6,862:8 63:7 74:1 75:1088:13 89:1,2,14 90:1192:19 93:11,16 97:10101:11 102:4,8 103:7105:7,12 112:19113:17 114:8 117:10117:17 127:11 131:3164:1 182:9,19 187:8203:7 220:11 232:16232:16 233:1 249:3249:12 256:20 259:10260:19 262:14 268:22269:2,4 272:17298:10 307:3

database 25:16databases 26:5date 19:2 36:17 87:1

205:6 228:8 267:19306:14 307:8

dating 148:13daughter 265:14DAVIS 1:14 116:2day 5:4 7:4 13:11,14

50:15 70:21 71:6,773:4 77:14 78:2085:12,14,16,20 91:392:5 96:1 99:20 104:5104:6 112:6,22 113:1120:4 136:3 144:15146:17 165:9 188:22189:3 190:6 199:5201:9 202:1 207:10207:22 208:5,10,11214:7,9 222:17229:12 255:15 260:3265:19 272:20 286:3288:5 289:14 297:11304:17

days 76:1 88:12 94:21113:22,22 130:15198:11 303:7 304:16305:6

de 2:18 4:14 137:2,3de-emphasize 215:2de-emphasizing 212:18deal 54:7 104:8 114:17

119:9dealing 53:21 294:2death 26:15 48:14

206:16,19 207:1,3221:22 222:20 227:19250:14

deaths 24:17debate 159:4Debra 2:22 269:21decade 153:4 210:12

218:14

decade-long 218:7decades 6:21 148:16

201:18 229:1,19242:3 271:1

decades-long 142:20decay 204:1,4December 263:6decided 25:7 35:15

76:6 91:4 265:8decision 211:16decision-makers 243:3decision-making 18:19

19:3decisions 7:2 49:5,9

121:3 140:9 147:10211:10

decline 157:11 184:18declines 164:3 184:16decrease 33:9 38:16,17

55:13,18 145:1181:14 201:9 225:11225:15 256:18

decreased 28:13 29:2255:13 144:4,9 257:20

decreases 283:19288:18

dedicate 9:5,12dedicated 182:13

210:12 234:20dedication 11:1deeper 89:8defer 97:18defiance 190:11deficiency 263:6 289:4deficit 217:4define 71:18 188:10,19

189:6 284:21defined 33:1 47:13

74:19 82:5 84:12 86:587:11 153:19 156:22274:2

defines 24:16defining 41:3 284:15

285:12 304:3definitely 51:15 67:13

187:3 305:12definition 22:6,12 43:11

45:1,3 46:16 47:12,1374:18 75:1 88:7 133:6150:16,18 229:15

definitions 21:20,2246:12 284:13

degradation 235:3degree 37:13,15 39:11

63:16 65:9degrees 235:12 265:7dehydration 298:12deli 160:12


318

deliberation 292:16deliberations 11:9 70:9

71:15delicate 235:5deliver 111:6,10 175:7

201:12,15delivers 200:5,12

300:15delivery 277:19Dell 238:13delve 265:8demand 289:9demonize 274:18demonstrate 161:15

236:21demonstrated 173:15

296:8demonstrates 183:16

246:11demystify 159:6density 167:11 184:17dental 203:18 204:9

206:1,3dentistry 202:18 204:16dentition 203:11denying 214:17Department 6:9 12:14

36:22 187:12 218:5234:13,14 238:21

Departments 16:1317:1 292:14 304:5306:8

depend 117:9 228:16dependence 135:3depending 61:11 63:2

64:16depends 103:2depleting 237:13depression 52:8deputy 5:6,9 6:1 11:4

13:10derive 27:18derived 248:20describe 14:5 44:12

203:9described 43:16 100:3

171:11describing 44:2description 44:16,17

44:21 63:7deserve 63:4 243:7design 15:7 95:12 99:9designation 240:21designed 61:18 132:6

213:6designs 26:12 86:7desk 7:18desperately 211:12

230:9despite 27:17 29:11

166:17 187:1 198:15199:3,11 202:4256:19 257:6 270:18281:20

desserts 167:6destined 191:6destroyed 231:22destructive 197:16detail 15:5,11 21:18

48:7 307:22 308:10detailed 15:15 169:9detailing 159:7 173:10deteriorating 235:6deterioration 236:7determinants 108:20determine 25:20 26:7

30:9 34:16 70:15 77:379:12 82:19 84:1886:10

determined 222:1determining 150:17

152:22 193:21 259:11detrimental 204:9Devastated 227:19devastating 235:1develop 11:7 36:10

88:6 133:15,21,21139:5 182:12

developed 180:9195:13 206:19

developing 85:9,1386:1 162:8 275:18288:11 302:14

development 134:16,18141:12 154:21 178:2179:11 182:4,14183:21 196:1 239:10239:15 261:21 279:3279:7 280:20 291:6297:19 300:12 301:20

developmental 52:14183:17

developmentally178:15 277:22

develops 251:9 307:13device 266:16DeVIRGILLIS 2:1 139:2

139:2devoted 306:6Dewey 1:15 94:13 96:4

96:8 98:22 99:6100:11,17 123:16,16125:15 278:14

DGA 249:15 267:14269:16 283:14 301:5301:17

DGAC 126:7 142:3180:5 182:7,17193:18 240:4 270:3270:14

DGAC’s 182:2DGACs 182:16DGAs 140:6,18 141:1,5

141:10,13,19 149:10149:22 150:9 163:21163:22 166:14 169:7181:9 182:4,12,15,20196:9 254:16 255:14269:6 290:11,16

diabetes 21:6 36:877:11,19 85:1,3,9,1386:2,12 95:14 96:9120:8 126:5 184:7186:14 187:14,18189:14 192:10 197:5197:17 198:22 200:16200:20 201:5 207:13208:7 210:15 215:14216:20 223:7,11224:12 227:17 229:6233:15 237:2 244:5244:14,17 245:21246:9 253:19 263:8273:21 279:14 286:1288:12 296:3

diabetic 281:22 282:21294:4

diagnosed 209:18Diamond 2:21 264:8,9Diane 2:18 246:18diary 72:6diastolic 83:21 84:2dictate 193:6didn’t 22:7 35:4 37:22

44:12,16 55:14 61:885:17 87:11 91:17,1892:13,15,22 94:5,2198:15,18,20 102:13105:2 111:19,22113:20 125:19 190:6211:14 214:8 227:20275:2

died 211:13 214:11227:16

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319

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244:5,10 256:8261:14

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61:9 102:18 106:15204:19 284:22

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236:8direction 40:14 63:14

102:3 196:1directly 10:1,16 91:13

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111:22documented 112:5

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117:4,8 123:6,13124:8 136:2 192:2193:5 195:6 227:13293:18 302:21

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DONALD 2:4Donovan 1:15 64:15

126:10,10dose 39:16 63:11 95:15

96:6 115:9 144:11178:9,12 207:15219:20 241:1

double 276:1double-board-certified

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192:5 267:1 271:3drastically 110:20

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171:2

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140:13 160:16 164:7164:22 216:11 219:11236:10 247:14

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53:11 100:9 115:8304:1

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262:8,10 263:1 276:9285:4 295:4 296:11301:4,8,11

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193:7 196:8 200:14

270:19 289:12 298:13educational 298:19educator 244:6effect 37:11 38:8,12,15

38:18,20 39:14,1754:19,20,21,21 55:655:13,18 56:12 65:967:12 120:17 204:10255:7

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111:11 115:7 174:13183:16 191:10 219:10220:3,5,8 235:21256:20,21 262:14

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239:17 303:3efforts 119:13 176:14

270:12,19 292:12eggs 197:3 198:8,19

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elderly 128:10 187:13187:17 193:15 236:1

electronic 21:2 25:1626:5

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245:14elite 287:2ELIZABETH 1:17Elsie 1:20 101:10 108:1embody 269:9embrace 255:18emerged 28:4emergencies 293:22


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271:10 281:16 287:12emphasize 39:20

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184:21emphasizes 180:6

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292:15engaged 273:18Engine 198:3

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271:11 300:16 302:10enjoyable 122:11 185:2

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234:12environments 196:9EPA’s 178:8,13EPIC 233:1epidemic 210:21

224:11 225:12epidemics 189:13

230:7 244:17epidemiological 233:7epidemiology 220:11

232:18epigenetics 126:20epiphany 264:17episode 125:21 126:2epitomize 290:17equal 67:14,15,15,16

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example 7:22 17:623:17 35:14 58:1176:2 79:22 80:12 87:587:10 124:22 125:9125:22 128:9,19134:13 153:16 157:2162:17 167:18 185:4226:6 242:9 243:17259:18 292:5

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199:21 215:5,6farming 234:11 302:11fascinated 58:17fasting 73:4 90:16,21

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150:16 163:21 179:18

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161:18 303:19federal 5:14 122:2

166:20 172:6 196:2199:5

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139:13,21 140:3,9,13141:3,7,16 142:8166:20 183:15 187:13278:11,20,21 279:4281:2

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93:19 130:11 135:19figures 225:13fill 181:21filtered 296:21final 138:16 140:15

182:17 194:3 249:19finally 57:21 88:19

89:15 141:19 165:12168:6 179:7 220:17230:5,5 234:3 252:17

financial 204:17 218:11239:18

find 17:19 26:4 37:14


323

37:22 60:13 62:1873:11 77:2 78:17 79:881:9 85:16,17,22117:22 133:9 135:6161:1 214:20 227:4246:10 293:18

finding 27:20 85:19118:7 228:15

findings 24:7 32:1437:8 63:11 69:8 86:1889:13 140:4,10 142:4165:15 170:11,22171:20 172:11 175:15220:7,13

fine 20:8fine-tuning 306:7finished 69:14 106:1

138:13finishes 303:18firecrackers 276:2first 6:21 10:6 12:18

23:9 37:6,6 43:9 44:149:14 50:13 69:1176:16 77:22 129:3134:19 137:8 142:19146:12,19 156:16163:1 173:5 177:5183:14 186:8 192:22193:9,12 201:3 206:8232:18 233:6 244:9245:8 247:19 251:13252:13 254:19 255:11266:20 275:11 278:7280:1 281:14 302:21306:5

firsthand 11:9 273:15fish 28:7,15 33:13

65:17 66:15 177:11178:6,6 198:22250:19 262:15

Fisheries 261:16fit 18:4 42:4 136:10

151:22 168:22 272:22fits 40:2fitting 161:2five 53:7 65:4 72:21

77:6 79:5 80:7,7 81:684:3 106:6 141:13152:8 171:3 187:8198:11 212:20 214:16215:22 231:3 234:5238:19 255:1 264:14272:19 274:12 293:15294:14

five-month 260:3fix 273:21flavonoid 219:14,18

220:8

flavonoids 173:15174:6 175:4 218:8,13218:17,21 219:3220:3,5,16 248:19

flavor 160:2,8 161:11259:6,16 260:5,17,22

flavors 129:6flee 237:7flesh 131:21flexibility 155:16,21

217:11flexible 229:10flossing 203:14 205:20flour 159:13 179:5

197:10flow-mediated 218:22

219:5 220:3fluid 146:18fluoridated 203:15Fluoridation 204:2fluoride 205:3,4FNCS 5:12 308:8focus 91:5 118:19

131:8 168:19 181:9181:17 189:5 195:5201:6 210:17 224:18230:21 251:1,9 262:3278:10 290:15 297:17

focused 14:22 15:1359:21 73:8 94:3 99:1113:5 135:22 178:5

focusing 40:15 68:1273:17 211:6 251:4

folate 143:17 167:20247:19

folic 178:18,21 179:2folks 7:5 11:5 97:18

98:6 303:22follow 9:10 11:8 63:7

93:5 101:19 237:15237:21 258:13 281:15

follow-on 141:16follow-up 39:6 78:19,22

79:10 82:2 84:4,898:17

followed 16:9 103:15227:3

following 16:15 28:531:11 55:3 140:14183:10 190:1 217:13227:12 228:12,14,17231:7 249:13 261:17264:20,20 281:20

food 5:9,12 6:7 15:2117:9 31:9,19 32:1336:13 40:10,16 43:844:16 48:1 54:22 55:856:21 57:3 58:8,9

60:12 64:11 65:1570:7,8 72:7 75:1,6,678:18 80:17,17 81:183:14,15 85:6 88:1689:1,5 92:7,7 108:4,5108:14,19 109:1111:5 114:1 120:8,19120:21 121:3 122:2122:14 123:19 125:11128:19,22 129:22130:20 132:21 133:6133:7,18 143:9147:13 149:6 150:19151:4 155:17 156:3,7159:21 161:9 163:17163:17 164:18 165:5167:7 168:9 169:15170:15 171:14,14173:13 176:13,15179:13 183:15 185:18193:6,20 194:13195:16 196:5,9198:16 203:7 207:8212:20 213:1 214:18215:2 217:16 218:6231:8 234:21,22235:5,15,19,20 236:4237:12,19,20 241:10243:11 251:3 263:9263:13 266:16 267:1267:6 275:5,18 277:6277:20 278:2,8 280:2280:16,18,22 281:2,5281:17 283:11 285:4286:11 289:11,20290:3,5,6,12,19 291:5291:16,17,18,19292:1,4,7,10,11,15293:1,6 300:10,16,20301:21 307:5

food-based 121:2,8290:17

foods 22:3,15 28:229:21 32:13 36:1340:1,10,19 41:3,1942:4 44:2,6,12 45:347:13 48:1 55:8 57:657:17,20,22 60:6,8,1260:16 65:3 67:5,16,1968:11 108:11,11,15108:16 110:14 112:12112:13 113:2,7118:13 119:10 120:11124:3 128:6 129:4130:3,20,22 132:10132:11 150:20 155:8159:10 163:2 167:3168:12,20 170:16,18

184:1 185:11 197:1,9197:16 198:2,8 201:3203:4 204:8 210:18212:5 213:2 223:4,9225:18,19 228:3232:2 245:6,9 252:16253:7 255:19 258:9258:14,16,19,20259:12,14,16 260:5260:17 264:3,22269:12 271:11 275:17276:14,15,20,21278:12 279:17,19,22280:14 290:19,20291:7,11,21 295:1,3301:9,13 302:1,6

forced 108:16forcing 199:4forefront 244:20foremost 90:9foresight 238:3forget 283:8form 194:16 232:13formation 8:20former 211:12 231:4

301:19formula 139:9,16

140:13,17,20 141:7141:20,20 297:22

formula-fed 142:2formulas 140:17 141:17

152:13,15formulate 198:17formulated 139:6formulations 160:15forth 55:12 66:11

110:17 114:5 119:14121:4 174:10 216:6

forthcoming 172:10fortification 179:3,4

292:7Forty-nine 281:7Forty-seven 273:11forum 49:18forward 8:18 15:7 16:10

17:12 36:1 41:10 46:951:17,22 71:14 105:2107:22 108:19 124:22134:1 148:21 190:19200:9 303:12 308:15

forward-thinking237:16

found 83:8 85:11 95:1195:20 144:2 170:15172:3 174:16 204:12204:22 219:20 222:8222:16 223:9 227:7239:1 248:6,7 249:3


324

257:18 263:15 265:9275:16 280:13 302:5302:6

foundation 24:14 158:9158:14 159:6 161:17171:1 253:12

four 51:10,11 141:9146:11 147:17 149:1163:1 177:4 187:17191:21 203:22 209:19229:19 232:15 235:9253:21 271:1 305:12

Four-day 78:18fourth 6:3fraction 205:2,3fractures 153:22frailty 184:19framework 24:13 36:11

42:20 43:12 44:8 46:946:13,19 47:7 48:552:4 73:14 76:20 78:483:3 134:4 163:17165:16 240:12 269:11

frameworks 24:13France 237:17 260:9frankly 208:19Frantzen 2:10 199:17

199:18 202:10free 18:21 138:13 243:7free-fatty 265:19free-living 260:2frequency 4:9 16:7 22:4

69:9 70:1,12,13,16,1971:4,10,12,16,18 72:772:10,16,20 73:3 74:674:12,14,19 75:5,1075:14,15 76:1,3,17,2277:3 78:1,5,10,13,2178:21 79:9,13,1680:18 81:1,8,10,2282:5,19 83:1,15 84:184:7,12,19,22 85:786:1,5,11,20 87:3,1087:13 88:9 89:4,9,1290:8 91:16 92:12 93:193:2,10 94:1,3,7,1294:16 98:15,19,21100:10 101:21 103:18104:3 105:10 109:7111:15,21 112:1,6,18113:11,16,18 114:12116:19 123:2,6,9,13125:18

frequent 235:17frequently 17:4 31:1

101:6,7 205:12frequently-asked 304:7fresh 124:6 143:3 281:2

291:10 292:7freshness 148:13FRIDAY 1:5Friedman 171:8front 162:18 241:3

307:9Frontiers 248:7fruit 67:1 68:7 197:12

247:10,15,15,22248:20,21 249:1,1,3,4249:7,14 280:2

fruits 28:6 33:13 55:1065:11 110:16 124:5130:2 151:22 170:17174:12,17 177:10194:10 203:3 211:7219:8 224:20 226:17245:4 246:6 249:16249:17,21,22 250:17258:16 259:21 263:11280:11 281:16 296:13

frustrating 90:19 93:9Frye 2:19 253:5,6fuels 265:20fulfill 158:21 170:8

185:14full 9:17 14:13 25:20

26:3 112:21 148:13158:3 196:8 211:6274:9 278:2 279:10279:11

full-fat 255:4,9fully 158:2 173:9fun 54:4 261:7function 39:6 249:11

258:2functional 157:14

184:17 273:13functionality 160:3functioning 204:8functions 297:8fund 117:2 222:6funded 117:5 268:16funding 117:8,22further 159:3 218:20

236:3 271:19 304:6furthermore 185:13

224:22 294:22future 62:9 87:8 88:4

113:14 120:2 123:1126:16 150:22 151:20170:6,9 182:3,16195:5 227:18 234:17254:17

fuzzy 117:10

Ggain 77:8,21 78:2,3,11

263:21 288:17GAO 194:5 195:4gap 150:11 151:16

173:5gaps 141:14,18 181:21

182:6garden 226:9garlic 260:11Garrison 2:2 142:14,15gas 235:2gathered 113:13genders 110:4general 48:16 69:18

100:1 107:1 109:10109:12 110:7 113:6144:17,20 177:9186:10,11,18 187:2187:15 223:12 285:5287:7

generally 28:12,1729:17 31:11 33:1844:1,6 93:1 113:21159:16,18 163:18257:1 271:20

generate 89:10generation 162:20

182:15 278:11generations 170:6,9

234:17genetic 210:2George 218:6germane 203:5 293:3gestating 127:9gestational 77:7,21

78:2,11 126:5getting 10:20 18:21

48:12 103:6 105:7121:1 128:10 210:16211:1 288:22 302:4

gifting 271:15Gillum 308:3gimmicks 228:6ginger 260:11girls 101:14 126:15gist 100:1give 10:22 13:7 31:14

41:17 66:21 76:14115:10 123:10 137:9137:14 187:6 216:18216:19 220:14 283:18

given 6:17 18:17 42:854:7 56:11 130:8144:22 169:2 178:15185:10 225:12 226:7228:16 249:12 269:5

gives 16:16 48:7 116:9giving 18:8 136:13

205:1 220:19

glad 26:13 297:3,16global 163:12 234:22

235:4,9 236:12289:21 290:6

globe 235:21glucose 231:14 265:21

266:1glycemic 184:1go 14:3 19:17 37:5

41:10 53:4 55:1668:22 94:7 107:6116:13 121:15 134:1136:15 190:10 252:4260:19 265:4 267:17281:8 282:3 283:16305:9 306:15

goal 162:11 170:2200:9 234:15 267:15

goals 303:14goes 115:5going 6:12,16 14:3,15

35:7 42:11,14,15 43:246:11 49:3,12,19 50:750:11 53:4,12 54:564:3 68:1 69:7,1575:18 77:12 89:790:17 105:2,16,18,20107:6 108:19 112:9112:17 121:15 123:1124:15 128:4 136:14137:6 190:19 191:21216:14 217:6 241:19261:1 262:1,3 275:4276:7 293:17

gold 269:2 286:13gold-standard 301:1Goldner 2:12 209:13,14good 5:3,21,22 6:2,11

7:19 8:10 20:11,1239:1 43:21 49:1 50:1964:7 65:9 66:10 74:1790:13 92:18 110:14113:14 117:11,18125:7 126:18 131:1131:15 136:15 137:2137:3 142:14 143:15145:16 153:6 158:8161:22 166:3,11169:13 172:20 176:8183:2 186:5 189:5199:17 202:15 206:7211:18,19 215:12218:2 221:4 227:1249:19 253:5,12260:8,15 261:13264:8 266:12 286:7294:18 296:18 297:11297:20 299:2 300:1


325

goods 145:21gotten 58:18 113:4government 7:21 8:19

8:21 127:14 129:12172:6 181:8 195:16237:9 290:4 298:20

government’s 227:6Governor 217:5,5grad 240:7grade 77:5 232:11

267:22 296:7grade-limited 268:1grades 34:22gradient 32:16 85:15gradually 281:21Graham 2:5 166:3,5grain 28:7 177:10

224:21 302:2grains 33:13 55:11 67:1

130:2 151:22 167:5170:17 174:12 177:13179:2,17 197:13203:4 226:5,18229:12 245:3 246:6250:18 258:16 263:12280:12 296:13

gram 276:15 277:6grams 121:3,14 143:14

146:18 156:22 188:21189:2 207:9,18,22208:5,10,11 222:12222:16 265:10,10272:19 283:9 285:12285:15,15 288:1

granted 212:20,22graphic 298:21 299:2graphics 298:17grapple 66:12grasp 124:20grass-fed 198:19grassroots 239:17,17grateful 7:4 26:17 162:6gratified 240:13grave 115:1 284:12graze 99:21grazing 99:20 100:8

102:10great 13:17 36:21 54:7

104:8 215:3 224:16228:11 231:18 232:8279:20 300:15 301:22302:19

great-tasting 300:9greater 8:13 23:19

161:13 179:14 268:10287:12

greatest 136:4 290:5303:20

greatly 163:6 225:20,22226:4 229:17

Greece 80:9 83:11greenhouse 235:2grew 266:20grocery 65:19 301:19gross 199:12grossly 241:22group 50:6 54:22 56:21

58:9 64:13 89:2,595:11 99:19,20 100:6100:8 119:16 122:15133:8 143:2,9 151:5173:13 203:8 215:2217:1 218:5 219:16239:12 245:19,19,22248:18 249:14 255:12267:12

groups 32:13 36:1340:10 48:1 55:8 57:373:20 80:11 83:1399:18 108:5 110:5120:9,10 124:8 128:6133:6,10 169:4 181:2212:21 263:10,14285:1 290:19 298:4

grow 302:7growers 166:7 246:21growing 164:11 181:7

184:4 205:8,11 215:9284:8 291:13 302:12

grown 291:11growth 21:5 36:7 77:9

77:17 79:17 81:8,1182:1,20 95:9 101:12106:11 134:15,15,18141:12 154:20 171:3183:17,21 184:9300:12

guarantee 151:5guess 41:5 126:11

127:5 133:12 134:6guidance 5:18 109:13

146:10 148:4 173:7179:16 180:7 181:6186:22 193:1,13,15205:22 220:14 280:8298:16,21

guide 151:10 160:22224:8 241:10

guideline 175:6 274:7guidelines 1:1,7 5:4 6:4

7:1 9:21 10:2,8 11:713:13 16:19 17:1420:20 22:20 29:1531:3 35:21 40:2 70:170:5,11 71:2 89:15109:20 116:16 120:3

121:21 122:1 123:4137:11 140:15 142:5142:18 143:1,8144:16,19 146:3,14146:20 147:4,11,18150:22 152:21 153:1153:8,14 155:16156:18 157:19 158:4170:3,12 171:12172:2,7 173:6,9 174:2177:8 183:9 184:21185:21 186:9,17187:1,7,20 188:3,6190:2,6,9,18,20 191:3192:9 193:6,11,12194:3,15 195:6,8,14196:6 197:11 198:17200:7,19 202:20203:12 205:18 208:9209:3,9 211:5 212:17213:13 216:14 221:18223:3 224:6,14,16,19225:14 227:4,12228:12,18 229:3,8232:6,8 233:13 234:2234:15 236:17 237:18238:22 241:18 243:16243:18 244:20 245:13247:3,21 251:1,13252:12 255:12 258:13260:15,21 261:5262:10 264:21 265:17266:20 268:17 269:8269:9 270:17 273:3274:9,18 275:11277:4 278:10 280:10284:11 285:9 286:7286:10,20 290:10295:15 297:2,5,17299:6,11,19 304:10

Guidelines-related29:15

guides 29:17guiding 121:9 187:22gum 203:2,17 204:14

204:21,22 205:7,10205:21

Gustin 2:22 273:12,12gut 151:17 231:21Guy 2:20 259:3

Hhabits 279:9,13 297:20habitually 22:5half 104:4 144:20

179:12 181:14 208:11216:1 222:17,22228:10 229:10 288:1

288:9ham 160:13hand 94:7,7hand-eye 279:8hand-mouth 279:8handle 229:10hands 9:16 195:21

230:3happen 17:15 260:22

307:14happened 49:16 97:2

97:11 190:18happens 285:17happier 231:16 289:12happily 10:15happy 8:11 137:14

221:6 271:18hard 9:9 11:1 77:12

93:19 117:8,11124:20 169:21 206:10214:22 246:10 304:15

harm 240:21 286:6harmful 148:7 228:16harmless 257:6harms 177:21Harvard 189:12 223:2Haven 4:2 5:3,6haven’t 107:12 117:1

126:6hay 214:20,22Hazard 2:16 234:9,9

238:2,5,8hazards 221:17HCA 281:13HDL 176:2 266:2he’s 37:6 69:7 191:21

217:6 232:3,4head 42:7 136:20

172:21Healing 230:22health 5:14 6:9 7:12

12:14 21:17,17 35:1935:19 37:1 49:7,752:1,3 63:10,15 66:568:3 86:20 101:12108:22 115:11,20118:6 120:17 126:19127:4,10,14 128:16134:14 135:1 137:5139:15 140:13 141:4142:1 143:20 144:3144:12,12 148:3150:14 152:16,19153:4 154:8,17 156:9157:11,13,15 158:22159:1,9 161:1 162:9164:15 166:12 169:4169:15,16 170:5,8


326

175:8,15 177:16184:6,12 185:5187:22 193:16,20197:15 198:5 199:12199:13 201:6,14,19202:2,8,16 203:2,10203:13 204:5,10,14204:17 205:10,14,16207:2,5 209:1,8 210:1211:19 212:3 214:3217:3 219:9 221:7,14221:15 222:1,22223:5,8 226:14 227:4228:9,12 230:7 231:5234:4,14,16 236:5,8236:19 237:1,4,20241:11,20 244:19245:18 249:5,6,19250:9 252:8,12253:12,17,18 254:19256:21 261:18,21,22262:6,13 263:6 264:3264:9,12 268:4 269:4274:8 278:5 279:15280:6 281:13 283:3284:4 285:5 288:4289:13,15 292:15295:7,11,14 296:4,22297:12 298:9 299:3,9299:10 301:2,3,20

health-promoting170:19

Healthcare 152:10155:1

healthier 68:6 115:18121:10 127:15 162:20168:15 259:13 261:6272:10 289:12 301:8

healthiest 245:1healthy 25:5 29:16 31:2

31:8 65:14 80:2110:15 120:14,14123:21 124:10,14,17125:10 146:7 149:13149:19 153:4,5155:22 156:13 158:1158:17 161:16 167:7167:8 169:1 170:4171:4 172:1,3,8173:11 175:6 180:18183:11 186:11 187:2187:5 190:15 192:4195:1,2 197:19,22199:2 203:4 210:10214:18 216:17,17218:4 224:18,19,22226:6 229:20 231:7241:13 243:11,19,21

245:16 246:4 247:6247:12 250:12,12251:1,9 252:5 253:14255:5,7 259:16 266:6267:8,11 269:9274:15 278:7 279:2280:19 281:15 286:8290:15,17,20 291:1,7292:19 294:13 297:3297:8 298:14,20300:11,11 301:5

Heaner 2:12 212:11,12215:9

hear 8:7,9 10:1,1664:14 68:16 125:19126:8 283:4 286:3

heard 10:3 70:9 107:3126:6 128:9 130:16241:17

hearing 16:6 51:1464:13 107:8

heart 83:19 84:8 144:4184:6 197:5,18 207:7210:15 215:15,20224:12 225:5 226:13227:16 229:6 250:7250:13,16 251:17,20254:22 255:7 258:10261:22 263:6,8,17271:9 274:21 275:7282:2 294:3 301:2

heart-healthy 251:11heat 280:16Heather 1:16 42:16,17

69:12 90:19 91:21102:21

heavily 276:6HEI 247:14hello 12:19 209:13

244:4 256:7 277:12287:6 289:19

help 8:18 10:14 64:667:9,18 68:2 119:5121:2 122:22 130:8138:2 141:18 151:15152:4 159:5 161:1,15163:3 170:5 182:5183:22 184:15 185:14193:22 195:8 196:6,8200:10 212:6 219:3,9240:16 251:5 270:12271:5 272:11 287:21297:14 301:11 304:7307:6,8

helped 204:3 209:22210:13 260:1

helpful 99:7 107:10113:8 114:13 225:17

258:1helping 67:4 131:18

151:2 184:17 195:1196:18 204:14 250:11272:1 303:14

helps 24:14 59:13146:22 224:8 291:18

herbs 259:18,20 260:1260:4,17

here’s 49:14 124:14287:13

heroes 230:9Heymsfield 1:16 4:10

59:16 69:7,10,2091:17 95:17 96:7,1296:17 97:4,8 99:14104:13 105:6 106:17116:17

HHS 9:20 11:21 16:13137:6 142:3 148:20153:7 162:11 169:21175:5 195:4 202:21253:20 299:18 303:10307:4

Hi 212:11 224:1 230:19259:3

hierarchy 54:12 57:1358:15 118:12 119:10

high 40:21,22 41:2 57:163:2 68:12 82:10,1184:15 86:6 87:2110:21 120:7 178:20190:7,7 197:5 206:3214:19,21 229:5245:2 258:8 259:21265:2 287:15 288:12301:13

high-calorie 175:21high-carb 232:2 264:21high-fat 29:8 34:9high-fiber 150:13 207:8

207:11 208:17,22209:10

high-intensity 150:4high-nutrient 210:17high-protein 258:1high-quality 29:19 35:6

39:22,22 58:7,8,10183:20 184:5 248:8253:16 302:9

higher 28:5 29:6,8,1334:7,9 55:17 56:466:22 85:12 121:14154:1 157:5 170:16174:22 176:2 177:9184:15 187:14 201:1214:2 219:8 247:11247:14,14,17 258:2,4

258:4,5,6higher-protein 301:17higher-quality 57:6highest 142:6 178:12

206:18 276:15highlight 143:21 152:20

173:2 177:4 185:6218:20

highlighted 18:12174:1 226:10

highlighting 94:9 205:9218:16

highlights 29:19 202:22highly 184:11 243:5

275:22 276:4 285:6286:11

hill 293:14hinder 279:2hint 15:4hip 288:13Hispanic 178:17,20

179:5 200:17,22201:8

Hispanics 213:20historic 209:7history 147:22 230:8

275:7 276:9 301:10hit 42:13Hmm 86:13HNC 152:12,20 153:6hold 7:6 17:22 253:20

274:22 306:4holiday 271:15holistically 165:11Hollywood 293:16home 6:11,13,14,14

125:17 135:4home-delivered 194:13homemade 140:17homeopathic 278:4homes 200:8hometown 256:14honoraria 218:10hope 8:16 11:11 26:13

62:2 135:19 137:3142:3 148:19 193:14210:22 243:13 278:17286:20

hopefully 7:13 18:763:22 127:1

hopes 256:22hormone 275:14hormones 191:10horrific 269:4hospice 221:10hospital 190:5 244:6hospitalization 153:21hospitals 187:21


327

286:12host 159:13hosted 303:7hosting 8:5 13:21hot 221:19 222:4,17hours 88:12 99:22

242:15 265:3,5Houston 1:9 5:5 8:13

11:5 12:9,10 220:21221:12 281:13 287:8307:19

Houstonian 256:11huge 117:9 308:10human 6:10 12:14 37:1

166:12 211:19 223:5234:14 237:19 243:8249:5 275:7,18 276:8292:15 295:14 300:9

humane 243:1humans 213:6,7,8,10

214:22 222:4 275:20283:8 302:9

humbly 283:13hummus-type 260:10hundred 198:11hundreds 59:7,8

192:12 220:9 274:11285:21

hung 242:19hunger 5:13 191:9

283:5hungry 191:6,7,12

227:8 228:5 264:16265:3 266:3

Hunter 212:13hurting 231:13Hutchins 6:8hydrated 147:14hydration 163:19 298:3

298:5,6hypertension 83:20

84:3 206:21 207:13231:9 288:12 294:4

hypotheses 102:2hypothesis 232:13,14

II’d 38:10 54:1 95:5,10

99:9 107:5 155:15251:11 256:16 293:19

I’ll 19:20 31:14 71:1672:22 129:20 138:19238:15,18 239:14304:19

I’m 5:6 6:6,16,17 9:1114:3 39:3 42:14,1543:2 52:18 58:1 62:562:17 77:12 91:18

95:2 97:19 98:22103:5 107:6 109:12110:18 116:19 121:15124:12 125:12,14128:13 132:20 134:2134:11 136:19 137:3137:4,6 155:14 166:5169:14 170:7 172:20183:2 186:6 189:12189:21 192:16 196:13196:14,16 199:17202:16 206:7,8 209:2209:14 215:13,14,16215:18,21 218:3221:5,6 224:1,2,2227:2 228:5,12231:14,16,17 234:10234:18 238:12,12,14238:17 239:2 241:7241:19,21 250:7253:5 256:7,8,11259:3,14 260:8 261:1262:1,3 266:13269:22 273:12,13,22287:7 293:12,18294:15 295:12 300:1300:2,3 301:19

I’ve 39:10 116:18121:18 122:9,12129:21 135:20 190:15191:18 210:11,11212:14 217:12 221:12231:17 273:14,16277:17 281:10 293:14294:8,12 300:19

IBWA 296:20 297:1298:4 299:16

idea 38:12 39:20 40:1955:22 56:2 58:4 59:1266:10 67:6,10 115:8118:4,17 130:18131:19 269:5,9

ideal 55:4 129:2 245:19263:22 288:15

ideas 122:10identified 26:4,6,9

130:1 153:10 166:14182:7 185:20 196:4249:2 290:16

identifies 285:11identify 133:17 171:15

195:11 304:5identity 161:12IDFA 253:8IDFA’s 255:10IFIC’s 259:10IFT 289:21,21 290:2,11

292:13

ignored 241:22 269:3III 244:11ill 192:1Illinois 155:15illness 52:8 153:22

236:7 269:6,17illnesses 223:17illustrates 25:13 201:21image 31:15images 105:19,21imagine 43:9 293:22

296:6imagined 293:19,20immense 193:4Immersion 198:3immunity 280:7impact 30:9 67:20

108:8 111:1,10115:11 118:6 120:17132:17 136:4 151:3152:18 156:8,16163:14 170:20 193:4208:12 235:22 249:5262:4 303:20

impactful 216:19impacting 248:17impacts 115:14,20

223:9 234:21 262:13263:5 280:6

impaired 179:11 204:8impairment 52:9imperative 140:15implement 156:13implementation 122:7

196:2 292:20implemented 252:19implementing 148:10

195:16implications 119:2

133:20 159:9implore 264:1import 146:1importance 8:19

130:22 141:2 149:10150:13 155:16 180:6180:18,19 181:4182:4,18 203:13271:7 290:11 297:2298:8,14

important 6:19 7:2,6,87:15 8:2 9:2,13 10:1312:4,7,12 31:15 63:870:22 73:7,8 85:186:22 88:18,20 93:1594:10 100:14 105:2108:18 109:14 111:5112:19 113:6 115:22116:3 118:7 119:22

121:5 133:4 140:5146:4 147:1 149:15151:1 154:19 158:17162:8 163:18,20167:17 180:13 181:19182:6 184:14 185:20186:22 193:10 194:1200:1 203:3 205:9224:7,7,15,17 225:5251:4 259:11 266:18272:13 273:3,7 284:7284:20 291:10 292:6298:6 300:10

importantly 144:10268:13

importers 145:19impose 105:2imposing 217:19impossible 191:8 227:7

234:19impressed 8:17imprisoned 227:21improve 5:13 176:18

204:14 281:19 282:13282:17 292:12

improved 122:3 164:22190:14 192:5 228:10

improvement 110:1improvements 142:1

204:2 285:5improves 283:20improving 131:5,9

150:14 152:16 205:10218:21

in-between 278:22in-person 1:10 10:3,16inaccuracy 142:21inaccurate 188:18inaction 237:9inadequate 87:2INCA 139:20incentive 218:11incidence 144:9 181:13

205:1,8 219:10245:21

include 25:4 36:1366:21,21 72:2 74:2192:13 109:19 111:16111:17,22 136:18154:14 171:18 173:12177:2 185:5,11 192:8193:12 248:18 249:8249:21 252:14 266:8268:13,22 276:16280:7 283:14 295:19297:17

included 22:16 26:1028:16,21 29:6 30:3


328

33:16,22 34:7 44:1544:21 47:1,16,2080:22 83:5 87:1192:21 165:4 169:9174:4 175:19 220:9247:5 263:11 265:17299:1

includes 35:10 61:588:7 143:9 159:16224:20 232:22

including 10:1 14:922:15 24:3 27:1030:17 70:21 143:3147:5 149:7,10,17150:20 151:8 155:3156:1 158:19 161:5162:13 163:2 166:12167:9,20 169:1172:13 174:5,8 175:6182:9 183:11 188:13203:11 206:15 213:19220:2 235:14 239:13240:19 253:16 254:19268:21 270:19 271:8285:18 286:22 288:11290:19 296:21 300:11

inclusion 25:21 26:828:15,22 34:1 46:1948:2,6 75:2,4 83:985:4 205:14 274:2297:3

inclusion/exclusion23:21 73:15

inclusive 133:9,10income 108:14 123:19incomplete 232:20

233:8 256:19inconclusive 286:18inconsistency 53:20

93:14inconsistent 32:14

34:15 56:9 82:4 84:1186:4,18 87:9,13,16

inconsistently 87:18incorporate 115:16

252:12 274:11incorporated 91:1incorporating 170:10

273:4increase 145:10 151:2

207:22 209:3 221:21226:16 236:5 259:20263:21 274:17 281:22

increased 93:10,1196:8 100:10 104:4168:2 181:12 222:5222:18,20 223:11236:4 257:10,18

269:7 271:3 288:10289:7,7 298:8

increases 8:1 222:13225:4 292:3

increasing 100:9256:18 287:20 288:1

increasingly 70:18 73:7282:5

incredible 273:19incredibly 118:7incurable 286:3independence 135:3independent 9:18

56:12independently 25:18

204:15index 26:21 27:11

29:16 30:14 31:8 80:1133:15 247:12 248:1

indexes 31:2,4indicate 37:16 225:15

255:6indicates 151:17

167:22 187:8 296:1indicating 246:5indices 30:16,18 31:7,9

31:10 39:15indirectly 206:20individual 95:22 136:4

160:19 175:14 184:22237:1 289:22

individual’s 160:17individually 107:18

132:22individuals 9:6 13:2

22:20 121:5 137:15155:7 156:3 162:13193:17 269:11 271:11299:7 307:2,6

industrial 276:20industries 215:6industry 145:22 158:12

162:4 166:9 211:18242:3 247:1 271:22272:5 273:2 289:11290:4

industry’s 164:7 270:11inedible 302:8ineffective 282:4

292:13inequity 124:10inevitably 238:6infancy 280:9infant 62:8 139:3,4,8,13

139:16,20 140:2,9,17140:20 141:7,20,20141:21 142:8 178:3179:8,12 297:22

infantfeeding 142:4infants 25:7 128:1

139:6,11,19,22 141:9141:14 176:22 177:17183:13 193:13 278:17

infectious 236:6inferior 167:2inflammation 258:3

285:19inflammatory 219:4influence 60:11 168:1influences 297:7influencing 187:3influential 286:11inform 8:18 10:21 24:15

132:14 142:17 148:19183:8 187:7,11,20221:16

information 15:1616:21,22 17:2,7,1922:8,13 47:18 61:1488:16 89:9 99:8,15100:20 101:1 104:8105:17 110:8 116:15121:6 129:13 130:15140:2,8 141:6 146:4147:9 148:11 149:11165:20 169:9 181:20211:9,14,21 240:10244:21 283:19 304:2304:6,9,12 305:16,20306:2,12

informed 7:3 147:9informing 9:19 224:17ingestion 87:6ingestive 70:20 71:21

74:19 75:13 87:3 88:788:11,13,18 90:5104:5,11,18

ingredient 121:16151:10 159:12,13251:3 272:14

ingredients 148:14149:7,16 150:8,17159:8,17,18 160:1,15161:15 168:8,8280:13 291:19

inhalers 214:9,15inherently 150:21 172:4initial 72:17initially 93:22initiated 54:10initiative 148:10 157:22

162:20 272:5,6,12284:10

initiatives 162:16innovation 141:20

164:7 168:15

innovative 272:8inorganic 179:10,14input 12:4 137:10 162:7

180:5 216:19 290:10insecurity 88:16 128:19

193:21 235:20 236:4inseminated 242:10insight 220:6 270:10insights 140:1 292:18instance 44:19 57:10

66:17 294:5 295:16instances 292:1Institute 145:17 147:17

148:5 158:15 163:12222:7,22 259:5261:16 289:20

institutions 286:12296:9

instructed 99:20insufficient 34:15 79:12

82:18 84:18 86:10,18116:5 129:10 291:11

insulin 191:11 198:13265:2 273:21

insulin-resistant191:12

insurmountable 227:22intake 23:18 32:19

33:12 44:13 57:1558:7,10 67:10 75:591:16,22 92:6,13,1893:11 94:16 98:9100:5,7,9 101:22102:8,12,14 103:7115:17 127:4 144:11144:13 151:2,6 154:1155:4 156:20 165:7174:20 182:9,11,19183:17 189:2 201:3201:10 203:3 219:2219:14,21 220:8248:6 251:14 252:7252:13 256:18 257:9257:10,17 260:2262:22 263:9 270:13272:2 287:20 289:7290:13 295:19 297:15301:7

intakes 103:11 126:16155:18,20 164:22219:8 247:15,16,18250:19 255:17 288:1

integrate 128:8,14,14158:2

integrated 135:15integration 54:9 114:16intellectual 7:22 179:11intelligent 243:6 274:10


329

intended 186:10 187:1194:7 239:7

intensifying 235:16intensive 71:3intent 47:10 239:22intention 110:13inter-meal 87:12interact 12:17interaction 283:2interchangeably 81:19interest 7:12 24:19 25:3

48:21 56:2 109:9137:10 176:11 199:2239:16,19 266:17

interested 48:13 52:1853:14 54:1 134:11

interesting 37:19 40:848:18 62:4 63:2164:14 71:1 89:10 93:8106:2 109:6 122:20125:5 239:2 294:9306:15

interests 41:4 166:8Intergovernmental

236:11intermediate 35:11,17

83:5,7 84:4 92:1100:12

intermittent 90:16,2192:5 109:11 111:18111:21 282:14

internal 221:9internals 87:12international 22:9

149:4 234:11 253:7296:20

internationally 22:11internship 256:12interpretation 15:8interpreting 165:15interrupt 19:13interrupted 37:2intervention 23:3,4

73:21 74:3 75:9,1776:4 78:5 102:9103:12 259:19 285:10

interventional 72:12interventions 163:13intolerance 202:5,7intolerant 202:6intrinsic 151:11introduce 5:8,11 137:6introduced 140:12

146:21 162:15 275:11introduces 247:4introduction 6:3 298:1inundated 235:18invaluable 291:6

inverse 81:19,22 83:2293:18 100:21

inversely 157:2investigate 182:6investigated 257:16investigator 116:20involuntary 88:17involved 9:3 307:1involves 127:9 129:6IQ 262:18,20,20 263:2,3iron 143:17 184:2,11

185:21 302:4iron-fortified 179:17isn’t 50:2 53:12 86:22

96:2 97:11 100:12112:20 168:9 222:10

isolation 53:18 88:17Israel 231:5issue 39:7 46:3 74:4

109:2,14,21 123:20124:7 125:19 237:10268:2,3 270:22 271:5

issues 7:12 72:9 90:893:9 99:3 154:14159:3 166:9 195:12215:19 237:4 284:4

it’s 5:8,11 7:19 18:1419:14,16 30:2 31:1538:15 40:5 41:21 42:142:6,13,20 45:11,1245:17,18 46:3,11,2152:3 53:18 54:3 57:1957:21 60:5,9 61:4,462:2 67:6 68:10 70:370:22 92:4,17 93:894:8 95:3,4 98:2100:14 103:20 104:1105:2,17 106:1,1107:10 108:17,18109:6,9,15 110:3,3,4111:8 112:6,11,13,15113:7 114:1,9,17115:6,19 116:2,8119:14 122:11,20,20124:9,12,20 126:7128:2,21 129:1,3130:14 131:4,14135:19 146:14 168:15170:1 186:22 193:3194:1,12 198:19,21200:5 208:14,16214:19 220:12 228:6230:9 232:15 242:6248:21 259:10 266:19280:22 284:7 285:16286:19 288:8 289:15293:17 294:7 307:21307:21

Italy 118:21items 31:11 272:21

JJack 2:5 161:22 162:1Jackie 4:2 5:6 6:2 13:8Jacob 3:3 293:12Jamie 1:20 64:17,19

107:7Jamie’s 126:13Jamy 1:12 19:10,11

54:6,10,13 66:7,868:10 106:4,5 114:14118:2

Jamy’s 63:7Janet 4:14 137:3

138:22January 1:5 78:7

264:11Janus 2:17 241:7,7

244:2Jardine 2:17 244:4,5Jennifer 2:20 261:14Jeremy 231:19Jessi 2:7 176:9Jesus 4:14 137:2,4Joan 1:19 38:13,14

39:13 60:21job 10:17 224:16

260:16John 130:3Johnson 2:20 259:3,4joined 305:8joining 8:15 11:5joked 113:16joking 125:12Jonathan 2:8 186:6Jones 2:8 183:2,3journal 175:12 239:5,6

249:9 257:15journey 278:1Joy 2:6 172:21JPA 246:20 249:12judging 110:10juice 246:20,22 247:4

247:10,17 248:1,9,12248:15,21 249:4,13

juice’s 247:7juices 163:19 249:1

250:1July 164:11 171:16

202:21 230:20jump 20:6juncture 119:22jurisdiction 233:11justification 144:22

K

Karima 2:3 149:2KATHRYN 1:15Kay 123:16 278:13keep 15:17 46:18 47:2

119:1 216:12 251:8264:2 289:14 306:14

keeping 265:1 307:8keeps 107:13Kendall 2:3 149:2,2kept 47:7 191:20ketogenic 43:5 215:16

215:22 217:14 228:2284:21 285:14,15

ketones 265:19Kevin 305:9key 21:20,22 22:6 25:9

30:5 74:18 75:1 88:19124:3 156:15 167:19171:20,21 174:10182:8 236:17 252:15270:15

kidney 143:10 209:19kids 103:3 104:6 129:4

237:12 267:4 288:7killer 207:6 210:15

218:18 275:8kilogram 128:2 157:1kind 6:2 26:13 37:20

39:16 41:11 43:1644:20 49:18 61:2163:11 71:6 82:2 84:998:3,4 101:4 108:9112:9 120:18 127:5128:1,13 130:17,21131:4,14,16,20,21135:6 240:2 307:13

kinds 44:19,20 65:4117:4

King’s 204:16kitchens 65:19Kleinman 1:12 4:12

69:6 89:20 93:17103:16 105:4 106:3106:20 125:14 134:3

knee 288:13knew 124:14 191:4know 13:1,3 16:16 17:6

19:14 31:15 37:1738:9,21 39:6,7,1740:3 41:8,13,16 43:546:17 49:3,13 50:1153:15,19 55:10 57:1,357:16 58:6,14 59:1462:14,15,17 63:8,2264:1,3,4 66:2,1469:20 91:5,13 93:2194:15 95:6,10,20 97:698:2,5 99:2,10 102:16


330

106:12,14,15,16107:2 110:8,21 112:8112:10,13,15,22113:1 114:21,22115:3,5,10,11,13,15115:15,17 116:22117:5 118:4,15,22119:2,3,4,19,21,21120:1,4,5 121:6,7,8,9121:11,12,13,17,19121:22,22 122:2,5123:4,9,10 124:18125:8,22 126:11,14127:8,10,14,17 128:5128:12,13,17,18129:1,7,8,14,16130:19,21 131:2,6,17131:18 132:2,3,3,5,8132:9,21 133:10,13136:14,16 153:5170:1 189:13 191:5199:6 200:3 201:18202:4 207:1 208:14211:4 229:22 235:16236:3 240:8 242:9,13242:17 246:3 257:4267:11 275:3 278:6279:13,16 284:6295:4

knowledge 129:18132:4,14 158:2 242:4294:21

known 23:15 196:6249:18

knows 191:2

Llab 218:15label 29:21 120:22

151:10 176:16labeling 176:17 270:20

270:21labels 29:14 120:19

121:2,12,17,18148:13,14

lack 30:8 61:22 62:268:10 97:22 120:21158:22 174:11 182:13211:21 246:1 279:12

lacking 280:18lactating 176:22 180:10lactation 15:20 64:10

78:14 79:14 86:12,12127:22 134:13 177:7178:1,16 184:7

lactose 202:5,6,7 254:1254:3,5

lactose-free 254:1,9

lactose-intolerant213:19

Lactose-reduced 254:7Lana 2:10 199:18Lancet 257:15land 230:8 300:3

302:10landscape 24:3 235:20language 150:1large 37:10,18 63:15

115:14 123:19 145:18244:6 246:5

larger 107:9largest 20:16 30:13

82:17 225:6Larry 2:21 264:9last-ditch 190:11lastly 72:10 95:13

125:18 151:16 201:18late 134:12 288:7latest 259:10 261:17

304:12laughter 69:18launched 272:5 278:3launching 277:18Laural 41:20 47:4law 233:3,11lay 224:7layer 278:5Layman 2:4 155:14,14lazy 228:20LD 1:18LDL 276:5lead 54:16 57:6 142:6

169:15 202:16 237:12267:8 274:21 279:13301:11

leaders 141:21leadership 281:12leading 139:15 167:6

206:14 207:3,4241:11 270:5 271:8

leads 258:1lean 28:7 33:13 66:15

110:21 156:18 183:11183:19 184:3,5,10,14185:5,13 198:19250:18

leaner 300:22Lear 3:3 296:18,19learn 279:4 284:6learned 209:22 232:11

283:11learning 280:4leave 191:5 237:10leaves 263:1leaving 135:4led 141:22 176:14

301:19left 227:8legal 243:1legal-drinking-age

146:5legislature 217:7legumes 28:6 33:12

110:16 130:2 142:21143:2,4 145:6 170:17177:10 245:3 258:17

LEIDY 1:16 42:17 44:2245:5,10,15,17,21 46:446:8 91:20 93:2097:14 102:6 103:2,15111:14

lending 169:19 277:16lentils 143:6,11let’s 10:22 37:5 49:21

55:22 58:22 202:7leukemia 50:22Leukotrienes 239:6level 26:3 57:14 58:8,9

58:17 114:22 178:12201:22 209:4 235:18

levels 25:1 54:16 55:383:6 159:11 165:8168:2 179:14 204:19235:9 252:8 255:19263:22 285:2,16,19291:15

life 73:5,5 126:11 127:6128:3 131:7 134:7,9135:2 153:7,9 160:10161:9 167:18 168:5177:3 181:13 184:13193:9,21 200:3204:10 210:12 229:2243:7 264:14 265:9265:12 278:7 291:14

lifelong 278:7lifespan 300:9lifestyle 149:13 160:20

163:11 189:17 196:14196:17 207:4 208:20221:11 224:4 271:18291:3,9

lifestyles 204:3 289:13lighter 282:9likes 217:9Likewise 303:10lima 143:10limit 179:15,16 194:9

212:4 245:9,11 246:6280:12 284:19

limitation 98:3 277:3,4277:9

limitations 32:15 82:884:15 86:3,17 107:16

limited 101:13 116:5,8173:9

limiting 168:12 178:9185:15 211:7 245:13278:12 301:10

limits 33:1 175:4 179:8225:1

Linda 1:19 2:10 196:13232:22

line 144:16 233:19278:3

linear 219:20link 237:19 306:18linked 93:22,22 144:4

246:8links 5:15 58:6lipid 83:6 218:21lipid-lowering 282:22lipids 218:21 220:6Lipps 4:4 5:10,20,21

6:1 11:4 13:10 19:4308:8

list 20:14 31:13 41:349:13,19 51:14136:17 137:18 148:14178:6 203:18 273:10

listed 25:9 36:18 42:4listen 122:12listening 36:16 240:12

256:15 275:3lists 151:10listserv 17:14 304:10

305:22 306:1,15,19literally 275:7 276:19literature 25:13 36:6

39:8,18 41:11 56:6,1956:20 90:20 93:7101:8 114:19 118:16150:1 171:13 212:1261:22 284:17

little 7:7,14,17 15:430:1 42:20 48:5,749:5 71:5,16 75:1790:11 93:19 95:4,1099:7 110:16 117:2123:8,17 124:12,20129:4 136:16 168:11242:4 245:5 252:2260:11 277:13,18278:5,19 293:16305:10

live 5:5 229:3liver 49:22 50:6,22

286:2lives 10:13 211:12

212:5 243:12 244:15267:9 282:6

living 237:5


331

Liz 41:19LNCS 150:2,8Lo 190:13locally 291:11locations 307:18logical 97:12logically 213:9Loma 232:22London 204:16long 40:1 59:20 69:16

168:11 230:9 260:19267:8 271:14 304:16

long-shared 7:12long-term 134:22

236:22 237:20 246:2256:20 292:3

longer 40:18 231:12longevity 115:22longitudinally 103:1look 15:6,11 17:16

31:14 35:15 43:645:13 49:20 51:1955:20,22 59:1 60:461:13 63:1 72:21 94:6113:1 114:2 118:16118:16 121:12 124:1126:8 132:21 134:1134:12,17 148:21183:9 200:4,7 201:11214:19 240:11,17245:18 261:4 274:21308:15

looked 47:16 54:1456:17 57:4,8 61:1765:5 69:8 75:8 80:1280:13 91:14 92:12121:18 123:21 190:15228:21 248:20

looking 14:20 16:1033:3 35:11 40:10,2041:2,16 45:3,13 46:853:17 64:5,5 65:174:8 90:2 92:12 93:394:11 105:20 130:3134:6 136:19 194:6263:14 278:16 284:17304:11

looks 133:11 180:16lose 227:7,22 275:20losing 231:15loss 77:8,20 78:14 79:2

79:10,14 157:12,14198:15 204:6,6 246:3257:2 260:5,12 263:3282:17 288:16

lost 53:12 191:20 228:8266:6,7

lot 10:17 16:20 20:18

40:14 43:7,10,14,1750:7 56:2 61:8 66:2069:13 71:22 74:4 88:392:3 103:20 113:17114:6,8 117:15,17127:11 128:22 129:9129:11,12,20 131:9170:1 202:5 260:20294:20

love 270:8 271:11loved 214:7lovely 220:21loving 198:16low 40:3,3,4 61:3 66:16

110:21 150:21 161:3229:16 262:5,15,22263:16,20 282:10284:2,5 285:5

low- 149:5 150:7 152:3164:12,16,21 246:2

low-calorie 149:7,16,17low-carb 43:5 216:7,10

231:11,19 232:3233:14,18,19 234:6265:9 273:17,20274:2,12,15 282:8,13283:6,13,17 284:11284:16 285:11,14,15286:6,16,19 301:16

low-carbohydrate61:10 188:15,18,20189:6 190:12 191:15192:8 228:2,15256:17 257:1,4,8,22258:7 265:16

low-carbohydrates188:10

low-fat 29:7 34:8 55:11177:11 196:22 197:22198:21 212:19 213:14224:21 255:9 268:7281:15

low-income 124:2low-mercury 177:10low-protein 157:18lower 28:18 29:8 33:18

34:9 55:17 100:7120:9 164:22 170:18177:12 201:5 208:1245:20 247:15 248:1248:1,2,3 250:16251:17,20 252:4,15253:18 260:2 295:19

lower-income 156:12236:1

lower-quality 248:9lowered 175:20lowering 252:1

lowest 285:13luck 241:3lunch 69:1 71:8,11

107:2 121:15 136:7136:22 137:3 187:7194:14 221:20 224:8

lunches 176:18lung 51:10lupus 209:19 210:9,13luxury 108:13lycopene 292:6Lydia 1:13 60:18Lydia’s 66:14

Mmachinery 276:8macro- 22:15,18macronutrient 23:6,10

23:12,14 27:1,6,8,1531:20,22 32:8,11,1632:19 33:2,4 34:1235:3 36:14 43:15,2244:13 45:8 47:18,2148:3 55:21 56:12 57:861:9,12 92:6 93:3114:5 125:20 156:22

macronutrient-specific44:6

macronutrients 43:3,845:13,14 46:15 53:1753:22 56:1 57:2158:10,18 59:21,2260:1,5,7,9,10 61:7208:16

macros 213:16magic 39:21 285:16magical 279:16magnesium 143:17magnitude 59:6,6 63:17

184:18 264:4Maia 2:5 162:1main 46:2 72:5 159:18

239:2maintain 125:10 128:15

157:10 192:4 300:13maintaining 149:13

191:7maintenance 164:17

275:15major 70:5,9,18 174:15

186:8 204:5 212:20222:2 226:12 249:2249:15

majority 25:11 27:1930:4 92:20 172:3213:4 216:16 233:7275:17 286:22

making 10:19 60:17

108:7,20 121:2131:19 132:3 149:14180:11 211:9 254:4260:22 308:9

malnutrition 153:12181:15

manage 270:12 272:1managed 158:14management 152:4

164:14 165:2 183:22manager 246:19managing 149:18

297:14mandatory 179:3

270:19manner 114:10 178:19

302:22manual 26:3,9manually 26:6manufacturers 145:20

149:5,6 152:13266:16

manuscript 43:7173:18

manuscripts 218:16March 11:18 18:18

215:20 308:16Marcia 2:18 250:7Margaret 2:17 244:5marginally 32:22marinated 160:7marker 258:3markers 120:10 264:15market 139:5 147:7

198:2,8marketing 148:16 183:3Mars 202:17,19Martica 2:12 212:12Martin 231:19Martinez 2:13 215:12

215:13masa 179:4Mason 218:6mass 80:1 156:18

157:12 184:16 248:1266:22

massive 42:1 276:8massively 235:8materials 291:19maternal 127:12 181:3

206:15,16,17maternal-fetal 206:11matter 31:5 58:13 255:8matters 57:18 280:16Mattes 1:17 37:7 38:3,5

38:7 63:6 90:6,1893:5 96:10,15,18 97:597:9 101:9,19 104:1


332

104:17 108:3 150:4259:8

MAX 199:21maximizing 177:22maximum 67:20Mayer-Davis 1:17 39:3

54:5 118:9,10McADAMS 3:4 300:1,2McCormick 259:4McGUIRE 2:20 261:13

261:14McKinsey 163:12MD 1:12,12,13,16,18,19

1:20 4:10,12 196:13meal 66:17 111:18,21

194:13 211:2 225:11226:1,8,10 278:2279:11

meals 71:6,7 73:4 74:2180:13 81:15,18 92:495:22 99:19 113:2194:21,21 203:18205:21 224:9 271:2

mean 30:19 39:15 46:146:5 59:6,20 60:4,860:21 66:11,13 67:171:4,22 81:13 86:21101:7 102:22 110:7110:22 111:4,9,10,10118:20 119:15 121:17174:20 246:4 263:19283:6 307:21

meaning 144:12 157:5166:16

meaningful 37:13 108:7132:17 272:12

means 81:14,16 86:2186:22 151:18 172:5216:10 265:18 267:12

meant 61:14 229:2measure 72:10 78:19

90:12 95:4 103:3,19measured 102:22

104:16 198:8measures 87:9 106:10

205:20measuring 72:4meat 28:7,19,19,19,22

29:1,6,7 33:13,19,1933:20 34:2,2,7,8110:19 158:9,11,15158:16,20 159:5,7,11159:15,16 160:6,11160:18 161:2,5,10183:11,14,19 184:3198:7 199:14 210:16211:8 212:2 222:2,8222:11,12,16,20

223:4,10,15 225:22226:16 235:7 236:20245:14,14 258:20301:10,17

MeatandPoultryNutri...160:22

meatballs 226:11meats 159:6,19 160:12

161:6,14 177:13197:4 199:2 221:17221:19,20 250:20295:19,20

mechanisms 117:6mechanistic 220:6media 23:3 109:16

261:18 266:22media’s 254:15mediator 92:1Medicaid 216:21 217:3medical 8:4,12,16

147:22 187:21 189:12198:1 201:7,8 210:3228:17 238:13 256:13279:1 288:11 294:9294:10

medication 190:10medications 190:16

232:3 244:14 282:5282:21,22

medicine 7:11 8:5181:12 196:15,17198:13 206:11 208:20210:5 221:10,10,11224:4 256:9 263:7266:13 273:13,13281:13 289:11 293:13294:8

Mediterranean 29:1430:18,20,21,22 61:265:5,18 66:18 156:1167:9 185:4

medium 167:18meet 12:9 87:2 111:19

150:17 153:20 155:7160:19 180:12 193:19193:22 194:7,22195:18 234:19 255:16269:12 290:18 291:2291:12 303:14,15

meeting 1:3,9 5:5 6:47:7 8:13 12:11 13:2114:4,9,14 18:18,19,2023:2 42:19 49:4,1550:13 72:19,19 73:1673:19 76:19 95:1138:17 151:4 194:19196:5 202:21 239:1252:5 260:21 278:13

291:8 303:12 304:22305:12,14,16,17306:4,6,10 307:16308:9,16,18

meetings 130:15150:10 304:17 305:4307:12

meets 23:20Mellon 210:3member 1:12,13,13,14

1:14,15,15,16,16,171:17,18,18,19,19,201:20 19:11,17 20:1137:5,7,17 38:3,4,5,6,738:9,14 39:1,3,12,1339:19 40:7 41:1342:17 44:9,11,22 45:445:5,7,10,11,15,16,1745:20,21,22 46:2,4,546:8,14 48:10,17 49:249:12 50:19 51:2,8,1351:16,19 52:17,20,2152:22 53:2,3,6,8 54:354:5,13 59:14,1960:19 61:16,17,20,2162:11,13 63:6,2064:15,19 66:8 68:969:10,20 89:22 90:690:14,18 91:12,17,2093:5,20 94:13 95:1796:4,7,8,10,12,15,1796:18 97:4,5,8,9,1498:22 99:6,14 100:11100:17,18 101:4,9,19102:6,21 103:2,13,15104:1,9,13,14,17105:6,14 106:5,17107:12 108:2,3 109:5111:14 114:14 116:2116:17 117:21 118:9122:9 123:16 125:15126:10 129:20 130:13132:18 148:16 150:3162:15 165:18 238:21250:9

members 1:11 10:119:9 20:14 36:1969:12 146:1 148:5,8162:7 169:18 180:2193:18 255:10 270:8271:21 289:22 304:15304:21 305:7 306:21308:1

membership 253:8membranes 275:15memorized 51:21men 59:9 85:10,11,13

100:1 146:17 208:11

mental 236:5mention 34:20 99:13

238:18 249:22mentioned 30:6 47:6

73:6 74:20 75:7 80:687:7,19 106:8 110:18110:20 118:3 125:19126:6 225:18 240:18242:22 296:12 306:13

menu 199:14 270:20menus 176:17mercury 115:12 177:21

178:9,12merely 287:16message 63:19 108:5

111:4,7,10 127:13147:1 208:21

messages 127:17140:14 163:10 266:22

messaging 295:7,7,13met 1:7 25:20 26:7

64:21 79:19 83:9 85:4meta-analyses 144:1

174:1 207:15 255:6meta-analysis 205:15

257:15metabolic 157:13,15

248:3 264:15 266:2269:4,17 285:17

metabolically 216:17229:4,9

metabolism 275:14method 232:11 233:5,9methodologic 103:21methodological 40:14methodology 42:18

133:22 171:10 267:22methods 27:10,17 28:3

32:19 40:12 88:8105:16 119:9,13123:8,12 133:2254:14

meticulous 190:4Michael 2:11 202:16Michelle 2:23 277:13micro- 22:16,18microbial 160:4microbiome 126:21

151:18 280:5micronutrient 183:17micronutrients 44:14

208:15 213:12microphone 8:9 138:3migraines 214:4miles 6:14 300:7milestones 183:18military 286:13milk 125:5 139:12


333

140:20 141:7 197:20199:5 200:7 201:11213:5,6,8,9,11,22214:1,12 242:12,16248:9 253:10,15254:8 255:1 275:18297:22

milks 215:7 254:7Miller 2:22 269:21,22

273:6milligrams 165:9 260:3millimeters 115:12million 186:21 193:15

213:18 217:4 223:1263:3 273:17

millions 192:12 227:3237:6

mind 17:18 46:18 47:3107:14 112:9 119:1193:4 264:2 307:9

mindful 109:3minds 290:2mine 62:14 128:18

218:12minerals 166:12Minh 2:19 256:7mini-strokes 209:20minimal 151:3minimally 168:7 258:15

267:6minimize 165:14minimizing 177:21

250:19 277:6minimum 73:20 75:11

75:21 76:13minors 148:8minute 306:22minutes 31:14 137:17

138:6 203:17 305:18misconceptions 23:2misguided 256:22misinformation 159:4

202:5misinformed 228:20mislabel 197:9misleading 254:11misrepresent 156:19missed 45:2 104:7,10

306:3missing 232:19mission 212:6mistake 237:14misunderstanding

159:5mitigated 157:15mitochrondrial 276:4mixed 82:2 103:6

225:21

mobile-based 105:16123:7,12

mobility 157:15model 92:15 103:9modeling 15:22 17:10

89:2 108:4 119:14120:10 203:7 307:5

models 156:6moderate 146:9 163:4

165:9 240:19,20296:1

moderation 28:2133:22 146:15 227:11

moderator 138:9,20modern 181:12modicum 294:10modifications 304:4modulate 219:3Mohamedshah 3:2

289:19,20 293:5,8molecular 117:6molecules 275:22Molly 3:4 300:2mom 302:11moment 12:12 122:15

238:18moments 278:22moms 263:1Monday 306:10money 117:4 198:4month 75:15months 15:19 25:8

139:22 180:9 190:13194:5 210:9 278:14297:18 298:2

Mooooove 199:14moot 33:5 254:4morality 219:22morbidly 227:8 264:13morning 5:3,21,22 7:20

18:2 20:11,12 114:15mortality 21:4,13 24:9

24:16 25:15 26:1927:2,22 28:13 29:1029:18,22 30:12 33:1034:11,17 43:18 46:348:13,15 54:15 58:462:1 64:2 72:21 73:176:18,22 77:4 78:8114:18 134:11 174:9206:17 219:19,21222:14 223:11 237:3246:7 257:13,17,18257:20 258:5,5,6

mother 127:9 184:12227:15 242:14,17300:4

mothers 126:17 134:14

139:21mothers-to-be 179:1motor 279:8mountain 284:8mounting 279:1move 17:12 71:14

202:13 238:10 241:5244:3 246:17 253:3256:5 266:11 273:9281:7 293:9 299:20302:17

moved 73:9moves 124:21moving 15:17 40:13

107:21 122:22 135:14135:16 195:3 200:9263:5 264:19

MPH 1:13,14,17,18,201:20 4:8

much-needed 169:3MUFA 28:9,10Muller 2:23 277:12,13

281:4multi-year 11:7multiple 26:19 27:10

40:1 143:16 144:1158:1 160:1 168:22174:7 197:4 210:14219:3

Munish 2:14 224:1muscle 157:11,12

184:16myriad 279:21

NNADIR 3:1Naimi 1:18 48:10,11

130:13,13name 5:6 20:13 60:8

133:7 142:15 152:9166:4 169:14 176:9186:6 189:11 202:15209:13 212:11 215:13218:2 221:4 227:1230:19 234:9 244:4246:18 250:7 261:13264:8 266:12 269:21277:12 284:1 287:6

name’s 293:12named 57:4naming 65:14Nancy 2:11 206:8narrative 54:17 58:16

58:19 156:5narrow 143:4nation 182:7 230:7

243:17nation’s 234:3 236:8

253:10 270:21national 7:5,15 8:3

23:15 145:17 166:6,9182:8 183:4 186:19189:3 194:14 201:7,7204:4 219:15 222:21224:8 236:16 244:18261:16 270:1 298:9299:4 300:17

nationally 162:22277:20

nations 206:19 236:11237:16

nationwide 162:20native 256:11natural 135:2 276:21naturally 275:16nature 15:6 178:15

237:13NCA 270:2,5NCHS 203:21near 196:15nearly 30:16 181:15

187:16 203:21 214:11219:17 289:22

neat 42:8necessarily 47:1 97:12

108:17necessary 10:21 63:17

194:18need 9:3 48:2 62:22

67:8 68:12 69:3 88:588:6,9,19,20 94:6116:13 117:22 119:6123:22 125:15 128:1128:7,8 130:6 155:21178:5 179:15 182:7182:18 200:18,19216:18 217:2,11,17217:18,20 226:15233:10,12 252:3259:14 265:21 269:14270:7 277:1 289:7295:6 301:7

needed 65:21 76:10,13210:5 227:14 252:20304:6

neediest 217:1needs 5:16 88:11 110:1

116:11 127:22 128:2128:9,15 132:14147:8 153:15,20154:3,18 155:8156:22 157:1,4160:16,20 180:12181:2,10 182:6185:14 192:22 193:22194:7,22 195:8 216:8


334

217:10 223:13 230:9251:4 252:6 267:21268:5 290:18 291:4,9291:14 298:3 302:12302:22

negative 81:17,20241:20 255:7 279:13

negatively 248:16neither 102:3 241:13nervous 232:1 275:15NESR 14:10 20:21 21:8

24:10 25:18 36:489:17 97:18 239:20240:1,2

net 84:9 156:8 262:14neuro 52:3,6neurocognitive 21:17

35:19 49:7 52:19178:2 239:10 249:10

neuropathy 231:9neuropsychological

52:8never 39:10 190:15

209:22 266:3 307:21Nevertheless 38:5new 16:17 51:7 65:3

69:22 70:3 71:1117:22 128:14 178:14180:8 192:9 197:10203:1 204:12 212:13215:5,13,17 216:21221:11,18 239:11247:7 249:12 252:12272:8 307:13

newly 265:14news 260:8nexus 127:3NF-kappa 219:5Nguyen 2:19 3:2 256:7

256:7 287:6,7NHANES 93:11 182:9

233:2 247:9 272:17NHLBI 101:12niacin 185:18nice 114:19 124:7

128:20 130:14,17,17131:14 220:20 305:5

night 8:22NIH 268:16nine 101:14 143:14

166:2 171:22 203:21nine- 101:12Nineteen 268:20Ninety-five 79:4nitrate 159:19nitric 219:7no-calorie 149:5 150:7

152:3 164:12,16,21

nodding 136:20non-alcohol 147:15non-alcoholic 162:4

286:2non-chewing 204:21non-consumers 248:4non-dairy 254:6non-energy 74:22non-energy-yielding

87:17non-industry-funded

246:11non-juice 247:12non-life-threatening

294:3non-meat 159:17non-reputable 140:18non-scientific 234:2non-significant 96:19non-starchy 60:22non-tea 219:15nonprofit 158:10

176:11 256:9Nordic 65:3normal 191:7 198:14

267:4,7normally 71:6 80:20north 158:14 172:21

300:7notable 175:16Notably 28:13notation 295:16note 16:11 17:20 18:17

69:2 116:3 138:16150:22 197:20 200:9239:14 272:13 295:15307:15

noted 11:10 19:4 37:873:22 74:12 150:3,9164:10 174:7 220:9298:9

notes 51:20 135:19298:10

notice 32:3 47:12 97:2110:12

noticeably 298:18notices 17:15notification 305:21notify 306:1noting 100:4 149:10

165:6 236:16notion 118:11 119:7

122:5nourishing 302:9NOVA 168:14NOVOTNY 1:18 40:7

61:21 62:13 91:12104:9,14 132:18

Novotny’s 54:8Novtony 132:18NPC 166:6 167:12

168:4,18nuance 68:10null 33:3 67:12number 24:17 43:21

70:20 71:10 73:9,1273:17 75:3 76:1380:10,14,19 83:12,1685:8,15,18 86:1687:15 88:11 90:3 91:394:16 119:13 121:4121:14 131:6 137:21138:1,10 139:1140:16 141:1,5,9,13142:13 145:15 149:1152:8 158:7 161:21166:2 169:12 172:19176:7 179:21 183:1189:10 192:15 196:12199:16 202:13,13205:11 206:6 207:6209:12 212:10 215:11218:1 221:3 223:22226:21 230:13,18234:8 238:11,18241:6,15 244:3246:17 248:15 250:4252:22 253:4 256:5259:2 261:12 264:7266:11 269:20 273:10285:11 293:10 297:8299:21

number-one 210:15218:18 250:14

numbers 20:17 76:11numerous 165:7

218:15 244:14 246:5246:8

nutrient 89:4 141:14150:10 155:19 158:21160:16,19 167:10173:13 185:14 200:4201:10 219:11 248:6251:2,3 252:5 255:17257:10 290:13,18292:8,12

nutrient- 283:10nutrient-based 120:21nutrient-dense 29:20

130:20 133:13,18204:7 217:16 267:6276:14

nutrient-rich 62:20168:22 183:14 185:13276:21 300:10,20301:9

nutrient-void 276:9,19nutrients 22:3,16,18

47:14 68:3 108:11118:13 119:10 130:21131:12 143:17,20151:4 163:20 166:13167:19 173:14,20175:12 181:18 184:11185:20 201:12,13,20213:11 214:17 247:4247:9,20,20 253:16279:21 280:19 292:2292:4 302:4

nutrition 1:8 5:7,9,125:15,16,18,19 6:713:20 44:17 137:4139:3,4,6,10,15141:17,21 145:9151:9 152:10,13,14152:14,18 153:6154:3,6,7,10,13 155:1155:5 159:8 160:3161:3 163:8 171:8172:21 173:19 176:13176:15,21 180:1,3181:6,22 182:3,5,14182:16,19 187:11,20192:17,19 193:7,13194:6,9,16 195:16196:3,7 197:21200:11,13,14 206:1209:16 212:12 218:6220:12 230:21 231:3238:15,20 239:16246:19 248:7,14249:10 250:10 253:12254:20 256:10 261:15266:15 267:16 270:19270:22 273:15 274:15276:15 277:6,14,21278:6 280:10 291:12293:1 294:9,10,13300:15 302:15 303:6305:13 307:2

nutrition-related115:21 203:10

nutritional 8:2 67:4,19143:21 154:2,18155:2,8 166:10168:12 169:6 177:11177:22 180:22 181:1181:10 187:3 188:4224:9 230:22 254:2279:18 294:21 296:22298:16,21 299:2

nutritionally 170:4185:10

nutritionally-dense


335

143:5Nutritionals 186:7nutritionists 192:18

241:16 299:8nutritious 139:18 142:8

185:12 255:20 290:7291:20 293:6

nuts 28:6 33:13 65:1165:17 110:17 124:4170:17 177:10 245:4250:18 263:12 296:14

Oo’clock 136:9,21oatmeal 280:3OBBAGY 98:11 99:4,17

100:16 101:10obese 79:3 162:14

186:13 187:16 227:8248:3 264:13 288:10

obesity 77:10 79:1880:2 82:21 127:12,12127:13 144:9 154:16163:15 164:4 187:9189:14 206:12,20207:12 208:7 212:15224:13,14 225:12229:6 244:12,17246:8 264:18 270:21273:21 279:14 287:13287:19 288:7,9,15296:3

objective 234:19 236:9obligation 170:8 223:14oblivious 242:7observation 100:14

107:7 232:13observational 72:11

74:2,5,7,10 75:8,995:5 99:1 117:10173:21

observed 28:17 33:18obviously 84:9 94:1

125:12 134:11 261:3occasion 71:21 72:3,5

74:20 75:21 112:16273:6

occasional 271:17occasions 72:1 73:7,10

73:12,13,17,18 74:175:4 78:20 80:10,1480:19,21 81:2 83:1283:16 85:8,12,14,1585:18,20 87:4 88:1490:4 92:9 96:9 97:17114:2

occur 285:18 306:10occurred 96:22 254:17

October 247:10ODPHP 12:20Off-mic 69:19offer 143:14 179:16

183:10 229:20 254:2277:20

offering 163:5 229:14offers 151:18 167:19

183:20 253:17office 137:4 181:8

282:4officially 241:10offset 91:8oh 20:8 22:6 30:1 51:2

51:19 53:10 66:796:10 295:2

Ohlhorst 2:7 179:22,22oil 28:10 61:1 168:8

276:7oil-free 196:22 197:7

198:7,20oils 177:12 275:9

276:21 277:7okay 8:10,10 19:12,14

20:7,8,8 22:7 38:344:22 45:10,15,2151:8 54:13 56:1660:19 68:17,20 81:1481:16 86:13,15 99:6136:20 137:2 202:13230:11,17 256:4281:9

Okinawa 233:1old 178:10 209:18

253:22 275:1 298:2older 25:5 33:8 141:14

153:8,9,12,20 154:11154:17 155:3 157:3157:18 181:10,14,16184:15 187:19 194:7195:5 204:11 298:5,8298:11 300:13

olive 28:10 61:1OLIVEIRA 2:18omega-3s 263:17omnivore 156:2on-the-go 278:21once 10:4 53:21 56:16

89:16 97:3 110:18111:3 138:13 220:10303:5

one-half 144:14 178:11one-quarter 262:9one-size-fits-all 230:4ones 37:22 38:1 50:11

50:12 51:21 97:15ongoing 11:17 182:3,18online 14:15 137:13

open 11:17 19:5 49:18240:6 242:19 303:17

opening 4:3 16:5 36:19operate 158:13operated 300:7operating 233:12operations 243:2opinion 104:18 275:4opportunities 195:11opportunity 6:17,22

8:22 10:7 13:2 56:768:1 116:9 136:11138:11 140:7 142:9142:20 145:13 150:11152:11 162:6 166:4176:21 180:4 202:22206:4 220:19 224:5234:1 236:17 244:8250:6 255:21 258:21270:3 290:9 299:15301:22

opposed 285:13opposite 232:6opposition 236:8optimal 113:12 134:15

134:18 139:10 175:8208:22 295:13 296:14

optimization 155:4option 139:13 183:14

192:9 216:8 229:18230:1,4 233:14,21234:6 245:16 265:17266:8 274:3 278:22283:15

options 141:3 142:8151:1 163:6 164:8216:7,16,18 217:18217:20 272:7

oral 10:3 11:15 141:17152:14 154:3,6,9,13155:5 202:20 203:2203:13 204:14,17205:10,16 239:1255:21 302:17

order 4:2 94:5 125:17140:16 141:7 153:14154:2 188:10 242:15245:9 252:4

organic 198:20 277:19organization 153:4

154:8 158:11 176:12222:1 226:14 234:12253:9 256:10 289:21

organizations 226:13254:19 299:7

organizing 115:5organs 265:20 297:9original 55:5 73:2

originally 60:8 273:10Ossining 215:13osteoarthritis 288:13Otto 2:18 250:5,7ought 236:19 243:22ounces 146:18 174:14

262:8,11outcome 25:4 35:15

46:6 74:8 79:1 84:484:10 85:2,2,9 95:14103:20 114:18,20115:6

outcomes 35:11,17,2243:19 46:10 49:1052:4,7,10,12,14,1973:5 81:3 82:6 83:5,783:18 84:13 86:2092:13 95:9 106:10,13124:17 127:4 144:13152:18 159:1 175:15185:6,8 203:10205:14 206:15,15220:7 301:3

outline 37:20 270:11outlined 40:3outside 7:1 22:20 23:13

24:4 31:22 32:9,2234:13 35:3 44:13 56:160:11 188:16 293:14307:16

over-reliance 235:10overall 24:2 41:1 47:9

54:19 56:9,17 57:1457:15,18 59:2 61:568:5 85:17 100:2107:10 120:14 131:10131:10 163:14 164:6165:2 175:18 180:14184:20 185:12 222:14225:11 251:4 258:6280:5 297:7,11

overarching 173:7overconsume 235:8overconsumed 257:12overconsumption

301:12overdue 230:10overlooked 242:1overly 280:3overstepping 268:9overt 282:2overtake 211:1overweight 77:9 79:3

79:18 80:2 82:21162:14 186:13 231:9248:2 287:18

overwhelming 133:9196:21 241:15


336

overwhelmingly 10:15oxidation 218:22 276:5oxide 219:7oxidized 275:13oxygen 276:2

PP 96:16,19P-hacking 97:6P-R-O-C-E-E-D-I-N-G-S

5:1p.m 17:21 18:6 137:1

308:18package 47:9 200:4packaged 208:17packages 162:18 272:8packaging 145:19

148:13 164:9packers 246:22page 46:16 306:17pain 214:4 287:16pain-free 232:3Painkillers 231:20paint 264:10pair-wise 97:10pairs 301:22palatability 108:12

109:2 259:8 260:5,12palatable 108:17 129:3

291:20palliative 221:10Palmer 2:9 189:11,11pan 275:2pancreatic 50:1 222:13panel 236:11 285:6

296:10paper 47:16 159:7

161:18 239:5 240:17240:22

papers 35:2,4 77:13,1879:18,21 93:6 98:2105:10 240:5,11

paradigm 283:14paradoxical 100:22parent 135:12parenteral 152:14parentheses 142:22parenthesis 145:7parents 134:20 140:11

140:19 141:2 278:20288:20

parity 79:6part 15:16 16:17 55:9

70:12,17 92:17 112:4113:15 125:1 126:20132:4 163:3 164:7173:11 174:2 180:18212:13 225:8 249:14

253:14 255:5,20272:6 290:20 291:7

partially 79:5participants 76:6,8

186:16participate 137:20participation 8:20 11:6

12:4particles 276:5particular 17:17 28:14

46:20 66:17 110:3127:21 129:9 161:2180:19 219:13 224:13291:14 308:2

particularly 17:16 40:947:12 52:18 60:6 73:9107:16 120:6,13178:14 180:8 181:18216:7 251:15 252:16

partner 8:6partnered 162:19partners 6:9partnership 7:8,20

272:10parts 70:6 89:11passing 134:5passionate 221:7passionately 199:20passions 217:18pasta 159:14 225:22pastries 226:4patient 152:18 191:19

209:17 211:13 215:15231:4 283:1

patients 191:19 196:19197:3 208:21 221:8221:14 231:18 232:5281:15,19 282:10,11282:12 287:16,18288:10 294:12

pattern 15:21 17:1024:21,22 25:2 31:1740:20,21 45:2 47:1147:17 54:18,20 55:1,255:6,9,16 56:11,15,1757:4,12,15,20 58:5,859:2 61:5 89:1 103:14108:5 110:15 115:4115:18 118:18 121:10124:11 130:18 131:5131:10 132:8 144:18144:21 161:16 173:11177:7 203:7 224:18224:19 225:1 245:17247:6 251:2,5 267:13269:10 274:15 284:11284:13 286:6,16,17296:11 307:5

patterning 132:21patterns 4:7 16:7 20:14

20:19 21:3,13,16 22:122:12,14,22 23:6 24:324:3,9 25:15 26:18,2027:1,4,16,18,21 28:128:4,5,16,20 29:3,529:12,13,20 30:11,1530:17 31:20 32:1333:8,11,16,21 34:4,634:17 35:6,6 36:4,7,836:9,12,17 43:11,1445:8,19 56:22 57:160:12,16 63:5,14 64:664:11,13 65:2 66:2167:11,16 90:10110:11,15 112:11113:5 118:12,12119:7,11 120:15122:6 123:22 126:16130:16 134:5,7 135:8145:4,11 151:13,21152:1,5 158:18 167:4167:8 169:1 170:14171:14,19 173:1175:18 180:19 184:20188:9 193:8 196:5230:2 251:9,11 255:5255:16 268:11 269:15286:21 290:15,21291:1,8 292:20295:19 296:2

paucity 90:11pause 12:13 20:4,10

252:22paying 304:16pays 127:18peak 244:15peanuts 124:4 143:3peas 142:21 143:3,6,11

145:6pediatric 287:11pediatrician 287:7pediatrics 139:12

179:18 238:14 254:21287:9

peer 14:16 171:17218:15

peer-reviewed 88:22239:5,5 246:5

pending 237:11people 6:12 9:3,5 19:17

21:21 57:3 59:1 62:1765:16 66:2,20 67:4,967:18 68:2,5 70:774:17 76:13 104:20105:7 112:13 117:15121:2,10,13 122:1,3

123:20 129:1,4,22130:12 131:19,22136:17 137:18 147:12147:19 154:5,11187:4,17,19,22 188:5189:15,18 191:6,7192:1,12 193:19200:10 205:11 210:13211:1,4,5,20 212:4213:15,21 214:3216:4,5 217:2 223:1223:15 227:3 229:4231:15 244:13,14,20245:1 246:6 250:11254:5 256:21 260:20268:5,16 273:18,20274:4 276:13 277:5286:8 294:16,21300:16 301:11 302:1303:16

people’s 90:9 126:9212:3 294:16

Pepin 2:9 192:16pepperoni 221:20perceived 158:22percent 23:19,20 32:18

32:18 37:9 38:16,1779:4,5 108:13 139:8146:2 162:22 163:22181:15 186:12,13187:9 188:14,21199:6 200:8 201:15201:16 203:21 204:1205:2,2 207:20 208:3208:6 213:19,21216:10,13 222:5,18229:7,9,16 233:20247:3,10,11,22 248:2248:3,12,15,21249:13,17,22 252:4254:8 259:9,22 260:6274:2,5,7 283:7284:14,18,22 285:2286:9,17 287:17288:7 289:1,3

percentage 60:2 156:19157:6,20 287:15

percentages 285:13perception 294:17perfect 131:3 132:9

213:5perfectly 132:6 302:1performance 168:2

249:11period 11:17 19:5 24:18

74:16 78:3,16 79:1091:10 112:1 260:4303:17


337

periods 74:13 75:11,2298:13 135:2

perishable 161:9permits 137:19peroxidation 276:3Perry 308:3person 10:8 137:14

148:2 162:21 241:14242:7,9,13,17 244:10244:11

personal 269:12 282:8291:3,8

perspective 43:7 58:3122:6,7 236:19

pertains 241:22pertinent 188:7pharmaceutical 266:16phase 9:14PhD 1:11,13,13,14,14

1:15,15,16,17,17,181:19,20 4:5,8,11200:13

PhD-level 300:3phenomena 122:20Phoenix 266:21phone 105:11phones 105:7phosphates 159:20phosphorus 185:18phrase 111:12physical 101:5,17

132:10 149:11 157:9physician 154:4 189:12

190:1,17 191:18196:14 209:15 221:5224:3 293:13

physicians 221:6241:15 256:8 285:7285:10

physiology 70:18,19phytonutrient-dense

174:5phytonutrients 173:20

174:15pick 108:15picked 85:19picture 86:15 264:11pictures 105:8 307:20piece 68:6 113:10 126:1pies 226:3pig 183:5pilot 99:16pin 7:17pinto 143:10pivot 58:21pizza 225:22place 18:12 78:18 80:8

83:10 85:6 138:14

254:17 268:20 299:13placed 162:17 167:4places 117:22plaguing 279:15plain 297:13plan 195:6,7,12 228:15

278:2planet 237:9planetary 238:8plans 195:4plant 210:17 215:7,7

245:1 249:17 258:9258:15 275:17 302:6

plant-based 29:17156:6,13 169:1170:16 197:1 198:7207:8 210:7 211:6212:4 217:17 223:4236:15,22 245:2257:21 296:12 301:14

plant-centered 258:8plants 143:2 236:20

302:8plate 60:22 66:14

128:20 175:9 225:8225:14 298:21 299:1299:11

platform 273:17 284:5plausibility 126:19play 151:12 154:18

158:16 167:17 174:2218:21 270:16 271:17

plays 193:21 296:21300:10

please 13:8 19:10 66:768:21 138:7,10,15139:1 152:2 198:17199:4,14 212:3,6230:8,17 233:18234:4 266:8 268:22277:8 280:15

pleased 150:15pleasure 5:8,11plenty 283:18Plos 263:7plowed 72:8plus 16:20 143:16

279:9point 14:7 19:10,12

46:22 60:20,20 64:774:9,11 78:16 92:2,1893:20 94:9 98:19100:8,12 101:20102:7 105:15 109:14112:3,6 113:13 114:3115:2 123:17 135:22136:8 174:10 188:8200:2 216:6 235:12

243:3pointed 90:19 122:16points 47:5 66:9,22

75:19 146:11 152:20163:1 186:8 198:11231:14 262:17,20263:2,3

policies 122:2 132:15152:17 286:12

policy 5:7,18 8:19,21171:9 176:9 187:20193:7 220:12 249:19267:16

Policy- 252:19policymaking 9:4political 170:21pollution 235:3polyphenol 249:2polyphenols 248:19,20

249:7polyunsaturated

251:16 274:19 275:10275:21 276:6,17

poor 67:12 126:16227:4 252:8 258:1

popular 109:16population 25:3 63:13

88:1 101:14 104:5109:17 115:13,17127:16 140:6 153:14154:20 177:9 181:7181:19 186:10,11,18187:2,15 195:9200:21 201:22 206:2213:4 286:9 287:11288:2,9 291:13

population-based252:19

population-wide 263:3populations 34:18 59:8

87:21 105:12 120:8120:13 178:18

pork 183:4,11 184:6,10184:14 185:5,14,16185:19

portfolios 15:14 21:1portion 123:19 163:5

163:13 270:15,16271:7,10 279:12287:2

portions 271:6posed 116:6,11position 139:12 153:16

217:10positions 281:12positive 65:8 81:7,13

81:14 106:7,8 115:7144:3,12 163:11

164:16 183:16 185:5247:8 280:6 301:3

positively 249:4 297:7possible 7:9 41:7

164:13 168:16 305:21possibly 120:2 130:17post 305:16post-assessments

102:12post-docs 240:8post-hoc 96:21post-study 103:4posted 14:15 240:6posting 239:12postpartum 77:8,20

78:14,16 79:2,9,14potassium 143:19

166:13 167:20 185:19185:21 201:16 247:18253:17 294:20

potato 166:6,7,8 167:19168:1,5,6

potatoes 62:17,18166:10,15,18 167:1,4167:7,9,17 168:8,21169:3,6

potential 115:19 159:1249:4

potentially 8:1 59:1162:7 115:2 120:21206:22

pouch 278:20 279:11pouches 278:21 279:2poultry 28:7 33:14

158:10,12,16,20160:6,11,18 161:5245:14 295:20

pounds 191:20 227:22228:8 231:15 232:4266:7 282:9,16

power 7:22 8:1 73:2176:9 230:5 273:15

powered 76:5powerful 59:3 63:19powerfully 197:2powerhouse 166:10practical 120:18 133:19

142:7 147:8 155:6163:10 180:12 181:5181:20 287:21 289:5

practice 180:4 194:4196:18 203:2 230:21230:22 243:1 273:15281:14 282:14 287:15288:20

practices 140:2 165:19196:14 205:16 242:8243:10 295:11 300:21


338

practicing 221:12281:10

practitioners 206:2pragmatic 147:9pre- 102:11pre-/post-but 98:1pre-conceptual 127:10prebiotic 151:17precedent 237:15,21precluded 171:6predecessors 237:22prediabetes 186:14

187:10,19 228:9229:5

prediabetic 227:9 231:8281:22

predicted 288:8prefer 259:7preference 160:17

254:15preferences 185:1

269:13preferred 139:13pregnancies 300:11pregnancy 15:19 64:9

64:20 77:8 78:2,4,10127:21 128:4 134:13167:19 177:7 178:1178:16 181:2 184:7206:15 239:9 262:12

pregnant 126:1 147:22176:22 177:17 180:10206:13 262:7,16

preload 74:21premise 167:1prenatal 178:18preparation 159:10,15prepare 9:20 299:19prepared 138:10 159:6

160:14 161:2,14preparing 20:22 159:18

160:5 302:21preponderance 233:4prescribed 43:8 154:4prescription 216:2

217:13 269:10presence 298:22present 1:11 21:11 69:7

86:7 171:5 203:16204:5 250:6

presentation 19:1821:19 69:16 89:7109:6 110:11 294:2

presentations 19:13109:22 305:18

presented 14:9,2118:14 76:19 255:22260:20

presenting 24:7 110:9238:17 244:21

presents 150:11preservation 160:9preserve 255:14president 162:1 253:6

269:22presiding 1:9pressed 246:10pressure 83:6,20,21

84:2 115:12 144:6190:7 197:5 198:13201:5 219:1 220:5229:5 231:13 282:18282:21 283:20

pretty 52:3 97:19101:13 106:1 110:4115:22 131:15 134:11260:15

prevalence 153:11164:4 178:21 187:14200:16 203:9 204:3214:2 269:7

prevalent 200:21prevent 148:8 170:5

184:15,17 208:18209:5 242:15

preventable 178:21207:1

Preventing 288:15prevention 137:5

203:13 218:17 244:22297:9

preventive 203:2 205:1205:3,16,20

prevents 288:16previous 72:19 124:18

142:22 150:9 243:14298:10

previously 149:9,22165:6 185:9 286:3

preyed 254:14prices 132:10primarily 14:22 97:21

106:19 108:12primary 97:21 109:8

158:19 159:12 183:15250:1

prime 243:17 244:15principal 218:4prior 180:22 235:14

268:20priori 97:13priorities 134:8 135:10prioritize 181:5 192:7prioritizes 163:17prioritizing 21:15 35:8

35:10

priority 107:21 134:19178:18

private 7:21 196:18230:21

proactive 163:9probably 48:20 50:10

81:12 94:4 95:18104:4 110:13 126:7

probiotics 278:4 280:6280:8

problem 62:21 68:7,891:2 120:9 190:20275:6

problematic 213:3problems 131:9 189:15

206:3 213:13,15234:4 287:14,22288:11

procedure 239:11process 9:4 10:5,21

11:7 12:5,8 13:715:17 16:16,21 17:818:7,18 19:3,12 25:1935:9 36:5 135:9136:15 137:11 148:9169:20,22 232:21240:2 267:20 276:7292:17 304:8 307:1,6

processed 28:18 29:733:19 34:8 159:5,6,7159:19 160:6,11,18161:6,14 168:7,12177:13 221:17,19222:2,8,11,12,16,19223:4,10,15 245:5,14250:20 252:16 258:15267:6 276:7,10,20278:12 279:22 280:3280:14,16 285:3290:20 295:20,20

processes 160:8processing 159:11

160:4 161:8 168:9,13168:20 280:17 291:16291:18 292:2,5

processors 246:21253:10

produce 139:8 146:1158:12 182:20 215:7242:5,11 270:8

producers 145:20producing 157:11

186:17product 159:12 160:14

160:15,21 168:15199:12 236:13 301:20

product’s 160:10production 242:8

275:14 291:6productive 267:8

303:13 304:22 305:3productivity 244:16products 28:16,19 29:2

33:17,20 34:3 139:6141:16 151:9 154:18158:12,16 159:8,14160:5,6,12,13,18161:2,5 168:6,10179:4 196:20 197:11197:17 199:10 210:8214:1 228:7 235:7,7238:6 242:5 243:21245:5 246:8,12,20253:11 254:1,11255:4,8 270:8 271:13271:22 272:8 293:6

professional 10:12180:2

professionals 8:11161:1 192:19 206:1241:12 261:19 268:4296:5 299:9

professions 290:3professor 155:14

202:17 212:12 218:5238:14 250:8

profile 160:3 190:14192:5

profiles 161:3profits 215:3profound 210:19profoundly 192:1Program 194:13,14,15

204:18 224:8program’s 196:2programming 148:17programs 5:15 128:17

166:21 187:7,13194:7,9,14,18 195:17

progress 9:7 150:15272:11

progressed 282:1progresses 8:21projected 115:13prominent 105:10

162:17 245:17 298:19promising 271:4promote 134:22 147:4

148:6 162:9 163:11168:10 170:5 197:9219:9 234:16 274:19289:6,12 298:15,20

promotes 172:6 198:22288:16

promoting 199:2 219:5Promotion 5:8 137:5


339

promptly 138:7proofread 86:14prop 7:14proper 10:21 183:20

229:15 268:2 298:6properly 188:11properties 279:5property 243:5proportionate 183:16proportions 22:2 31:21

32:5,6,17,21 34:1360:1

proposal 150:6proposed 165:16

179:15 194:8 284:12286:6

proposing 284:10prospective 26:12 30:4

37:9 79:7 80:7 83:1085:5 87:14 219:17257:14 295:17

Prostaglandins 239:6prostate 51:10 222:13

258:11protect 170:8 178:2

179:9 203:3 219:9protection 35:5 234:12protective 28:4,16

29:17 33:17 57:7protectiveness 55:19protects 288:18protein 23:13 32:9

44:15 58:11,12 66:1567:15 121:14 126:3128:11 143:15 148:12153:17 154:1 155:4155:17 156:3,8,15,17156:19,21 157:1,5,5157:10,16,19 158:3183:20 184:1,5,8,14184:15 185:13,17213:12 214:19,21228:4 235:11 250:18253:16 256:19 257:10257:20 258:2 288:22289:2 294:18,19301:21 302:4,9

protein-rich 183:21302:12

proteins 60:2 213:22224:21

protocol 23:22 203:5protocols 17:3 18:13

18:14 239:20 304:3,4proud 269:16 272:9proudly 199:18 300:19proven 191:14 258:9

287:20 292:8

proves 233:17provide 6:18 10:7 11:15

12:2 14:6 17:7 18:1548:16 58:16 116:9121:9,21 137:16140:7 142:9 148:11152:11 155:18 156:3161:6 162:7 165:19169:3 171:1 173:14174:16 175:5 176:17180:4 184:2 186:2188:4 193:1,14195:22 202:22 206:4220:6 244:8 255:21270:10 272:15 278:1279:18 284:5 290:10299:15 306:11

provided 22:8,13 23:21146:13 149:9 155:22202:19 218:9 300:7

provider 141:4 148:3providers 187:22 202:8provides 16:20 24:13

130:16 161:10 166:6176:12 181:22 184:10185:20 253:16 272:16

providing 122:1 139:10164:8 173:6 175:4,16218:3 234:10 243:19

proving 198:3psychiatry 239:15psychological 111:1,4

111:9public 1:3,9 2:1 4:13

6:18,22 7:4,12 8:8 9:310:2,6,10,16 11:16,1714:14 15:16 16:1117:12 18:5,8,20 23:343:4 56:2 68:3 69:4108:22 109:10,13110:7,17 113:6115:10,20 118:6120:17 128:16 130:8131:18 132:16 133:4136:8 137:6,9,16143:20 147:8 159:9164:15 169:15,22172:15 176:11 177:15201:13 204:5 211:17221:16 223:13 224:17236:17 250:9 254:13262:5 277:16 278:13289:6,11 295:7,9,12296:8,9 299:9,10302:17 304:7 305:4,7305:8 307:7,12

public-private 7:8publication 223:6

publications 114:3164:1

publish 92:6published 64:22 113:19

114:9 154:9 165:3171:15 173:2,18175:12 194:6 201:20207:17 218:15 219:16247:9 257:15 263:7268:22 285:8

publishes 172:6PUFA 28:10pull 65:9pulling 40:19pulse 142:16 143:12

144:2,11 260:10pulses 143:4,7,14,21

144:4,8,14 145:3,7,7145:10 245:4 246:6296:13

punch 279:18punt 50:10Purdue 6:19pure 146:18pureed 183:14purpose 121:20purposes 61:13,18

160:2push 238:8put 8:18 22:7 57:17

60:15 65:15 67:20108:19 110:6 112:20117:3 123:3 131:21172:8 216:3 244:19287:12

putting 11:12 13:4133:1 216:15

Pyramid 231:8

Qqualify 233:5qualifying 188:15quality 33:4 36:15

53:18,21 55:8,1257:19 58:5,9,11 67:1067:11 68:12 70:8,14130:20 131:10 142:6156:7 164:22 167:1167:12,14 168:10175:15 204:10 235:19248:5 278:6 282:19283:20 292:13

quantifiable 262:4quantify 63:16 74:5

88:8quantifying 74:11quantities 22:1quantity 70:7,15 115:9

156:7question 20:7 24:6,8,10

24:15 25:6 35:18 41:642:18,22 43:9 45:1848:18 49:1 50:19 52:263:12 71:1 73:1,276:16 78:12 79:1580:18,21 81:2 82:1782:22 83:16 84:2185:1,7 86:8,22 89:390:1 91:13,22 93:1594:2,19 97:15 99:11101:11 103:10,17106:6 109:9 115:8117:13 125:17 138:11

questionable 254:14questionnaire 75:14,22

80:18 81:1 83:15 85:7questions 9:15 11:14

14:8 17:4,17 19:9,1321:3,5,15 23:22 36:649:7 62:12 72:17 77:682:10 89:21 92:11,1794:11,14 101:20116:6,10,14,20129:10 182:2 239:8239:12 268:12 304:7

quick 257:2 277:17quickly 305:21 308:4quinoa 197:8quite 24:12 38:21 39:8

39:9,11,17 40:5 70:1180:4 107:3 110:6208:19

Quoting 269:8

Rrabid 238:5race 87:22race/ethnicity 30:7,10Rachel 1:18 41:15 54:8

132:18radiology 224:3rainbow 279:20Rainosek 308:3raise 63:12 146:11

152:17 217:8raised 200:15raises 103:10,17ranch 300:6rancher 300:2randomized 26:14

43:20 46:6 63:22 80:694:18,20 95:2,8 97:1599:2,5,12 116:22117:12 131:3 173:22191:1 258:11 295:18

range 23:14 32:18


340

48:22 154:14 158:3164:8 165:9 268:10269:14 286:21 287:19

ranges 37:21 155:19292:18

rapid 171:3 236:7rapidly 181:6rare 89:22 179:6rarely 87:6 88:15

244:10,11 307:12rate 27:12,13 82:11

147:13 206:12,17rates 84:16 86:8 87:19

204:4 236:4ratio 28:9 29:1 34:2ratios 39:4ravaging 230:7raw 291:18Raymond 2:1 139:2RD 1:13,14,15,17,17,19

1:20 4:2,8,14RDN 1:18reach 172:9reaching 200:19 288:4reacting 276:2reaction 214:11reactive 275:22reading 77:13 111:1ready 18:7 136:7real 41:6,17 107:21

119:19 193:4 200:7228:3 264:21 275:5276:14 285:4 300:16

real-food 265:10273:20,22

realistic 201:21reality 40:15 133:19

236:10 257:3 276:14286:10

realize 63:18 214:3,8realized 60:5 214:12

227:19really 17:22 18:19

20:19 35:4 38:2 39:1940:11 41:14,18 45:346:21 47:8 50:7 53:2054:9,10,14,15,1856:11 58:19,22 59:1564:6 68:2 69:12 72:573:8 74:17 87:1 92:1892:18 94:6,11 95:3105:15 109:18 112:11113:7,14 114:4,13,19117:5,12,18 119:17119:21 120:20 121:1121:16 122:9,15123:22 125:17 126:13126:19 127:3,7 129:7

130:11,14,17,19131:20 133:14 134:3134:14 135:15,21137:9,14 208:12,22217:2 294:6 303:8,8303:11 304:22 306:6308:9

realm 52:8rear 138:16rearrange 136:14reason 95:7 128:7

239:3reasonable 76:14reasoned 102:2reasons 82:14 140:13

201:2 213:3reassessed 223:8recall 49:21 64:11

96:14 106:18recalling 39:3recalls 75:12 76:2

114:1recaptured 123:14received 22:21 307:7receiving 186:21

279:21recess 68:19 136:22

230:15reclaimed 228:11recognition 13:5

234:22 235:4 274:1recognize 63:9 141:15

145:8 152:3 157:22169:5 186:22 237:18243:4,20 270:15284:7 290:19 291:10308:2

recognized 22:11104:20 155:20 159:21203:13 216:9 243:9271:8 298:14

recognizes 164:18recognizing 193:19

297:2recommend 141:10

145:3 155:2 168:4175:5,8 177:16 179:8208:10 209:9 212:3213:9 223:3 241:17249:20 251:14 274:15278:9 286:20 296:10296:10

recommendation113:14 145:10 149:21154:9 180:14 189:1215:3 262:10 268:2,3281:1 289:5

recommendations

41:10 62:10 88:2 89:594:8 107:21 108:8,20111:2,13 128:16129:12 133:3 140:5142:7 149:14 150:12151:5,7,20 153:1155:3 162:8 170:3173:8,14 174:22177:3 180:8,11,17187:4,12 188:4 194:2195:19 227:6 243:14243:19 245:7 250:22251:6 252:1,14,18254:18 267:17 275:1278:2 281:21 290:12290:18 296:7 297:21301:6 302:15

recommended 31:9139:18 144:17,19145:1 153:18 154:4154:11 172:2 174:18175:3 177:8 179:17181:9 190:2 202:1211:16 241:13 253:22254:22 255:4,15,17262:21 264:21 275:10290:22 296:11

recommending 50:5112:12 113:9 114:11203:14 213:14 245:11245:13 260:16

recommends 167:12168:4 172:8 195:7212:19 249:12 250:17280:11,12 297:10

reconsider 278:18reconvene 68:21record 15:17 80:17

83:14 105:8 114:1172:15 217:15

recorded 138:17recording 104:20recordings 305:17records 78:18recover 196:19recovered 215:21recovering 153:21red 28:18 29:1,7 33:19

34:2,8 177:12 223:3223:10 245:14 265:22

reduce 148:7,9 156:6,7162:9,21 204:3207:12,19 208:5223:16 225:10,22226:4,15 234:16235:18 245:9 246:12269:6 274:16 292:2

reduced 27:12,13 29:10

34:11 67:12 110:20157:3 161:3 174:8201:4 205:1 229:17249:8 254:1 257:9260:6,12 285:18,19295:21 296:2

reduces 161:9reducing 149:19 184:18

205:7 208:13 225:20226:3 276:17 292:9297:15

reduction 48:15 164:17236:12 252:14 260:13281:17 285:9

reductions 144:5reevaluate 167:13refer 54:6 143:5 305:15reference 99:5 155:18

165:16 178:9,12182:11,17 252:13

referenced 178:7referring 150:8refine 35:22 135:7refined 23:3 29:2,9 34:3

34:10 167:5 177:13226:5 250:20 251:19301:12

refining 21:14 35:8,9,12reflect 40:8 149:22

205:18reflected 33:3reflection 33:5 110:10reflects 220:13reformulate 168:16reformulation 292:8refreshed 274:10Regan 1:13 89:21Regan’s 89:6 120:4regard 35:5 56:7 112:21

115:1 119:7 146:10regarding 109:5,7

149:16 177:3 180:17183:10 184:20 233:8256:20 269:4 290:12295:13

regardless 29:21regards 295:9regenerative 237:12region 62:19regional 199:21registered 8:13 137:16

139:17 140:22 154:5176:10 192:18 256:8261:14

regression 27:12,13regular 155:8 222:17regularly 6:12 190:3regulated 161:4


341

regulatory 139:15162:1 253:6 270:1

reinforce 205:8reinforced 283:2reinforces 282:14reinforcing 204:13Reinhardt 2:6 169:13

169:14relate 23:7 131:9

175:14related 21:5,16 24:8

33:14 35:18 36:642:22 54:22 71:1272:9 94:1 101:5 106:6106:10 114:15,19115:6 124:17 141:11144:12 150:1 155:17157:2,8 173:3 192:20248:5 290:3

relates 54:8 70:1976:22

relating 135:11relation 305:10relationship 16:3 26:18

26:22 27:4,7 30:1134:16 72:20 73:376:17 77:3 78:1,9,1379:13,16 82:19 83:184:19,22 86:11,1989:3 91:15 93:18105:11 115:9 136:1144:2,11 170:14239:8 248:12 278:8

relationships 27:21219:21

relative 28:8 29:6,7,834:7,8,9 107:8 120:16264:4

relatively 28:18 33:18131:2 178:20

released 212:16relevant 91:10 170:22

171:15,18 182:20186:21 193:1,11,14

reliability 88:15 90:3reliable 267:18reliably 103:17 268:9reliant 282:5relieve 288:2rely 154:5remain 148:5 153:9

170:22remained 74:2 190:15remaining 21:15 27:9

35:8,10 72:21 77:6229:9

remains 156:13 250:14270:21

remarkable 27:19 39:1140:6 104:6

remarks 4:3,5 7:19 16:5299:21 302:18

remedies 278:4remedy 287:21remember 7:14 38:18

49:14,18 98:5,7 102:7103:5 232:10 265:4266:21 268:6

remind 14:16 142:19303:16,22 304:1

reminded 268:8reminder 11:16 18:13remission 215:15 216:3removal 25:17 277:2remove 140:8 176:18

215:1 243:14,16,18261:5

removed 74:2 94:2241:10,18 243:22

rendering 280:18renewed 205:19repeat 108:10 234:5repeated 111:2,3repeatedly 208:18

236:12 242:10repercussions 166:20replace 145:6replaced 121:1 197:12

225:9replacement 251:16

253:15replacements 288:14replacing 121:15

174:18 251:14,18276:19

replicate 232:17 239:21240:1

replicated 239:22replicating 171:10report 11:20 14:18

15:10 55:15 64:1068:22 69:13 88:16,1989:11,14 91:3 92:2298:20 113:20 136:3143:13,22 148:21170:11 171:11 172:10172:11 181:8 182:18183:8 186:19 192:22193:4 194:2,6 195:4195:22 232:16 233:14233:19 239:18 251:10261:2 264:1 306:5,8

reported 30:5 32:5,7,2147:17 79:1 80:9 81:381:7,21 82:7 83:19,2284:6,14 85:10,11,14

163:12 249:7reporting 30:8 75:13reports 15:3,19 16:1

18:21 82:6 84:13182:10 236:14

represent 87:22 129:16152:10 183:6 199:18

representing 145:17,18149:4 152:12 158:9162:3 192:17 206:8224:2 227:2 241:8246:21 270:6 284:2294:15

represents 139:4 166:8253:9

reprioritizing 49:6request 205:14requests 255:10require 154:1 157:4

159:10required 48:2 73:21

76:7 208:12 216:3241:13

requirement 73:22156:17 209:4

requirements 153:17158:21 179:3 194:17194:19 291:13 298:5

requiring 288:13research 1:8,8 5:16 7:5

7:10,16 13:20 88:1,490:2,17 94:4,8 116:11118:5 119:16,21124:8,12,18 125:2,16133:3,15,20 139:5141:21,22 151:16158:10 164:20 165:3166:15 167:11,15,22168:11 171:3 172:7172:12 175:11 180:3181:22 182:3,5,6,10182:14,19 183:15185:3,7 188:11197:14 203:1,5204:15 205:5,15210:2 212:14 214:20218:13 222:6,7226:12 228:1 257:22260:14 279:2 296:19297:6 300:19 301:14303:6 305:13

researcher 189:12218:7 264:10

researchers 167:6223:8 239:14 257:18263:15,19 271:1299:8

resident 210:4

residing 266:14resistance 157:17

273:21resolve 234:3resolving 93:14resonates 64:12respect 216:11respected 285:6respectfully 195:10

289:10responded 266:22response 39:16 56:18

63:11 95:15 96:6115:9 144:11 207:15219:20 241:1 253:2

responsibility 123:3124:9 129:2 139:10

responsible 148:7,15256:9

responsibly 148:18rest 229:13restaurant 176:17

270:20restriction 163:18

257:3 284:4result 22:19 84:9

108:15 132:9 202:2206:20 227:17 257:8264:19 286:18

resulted 26:10resulting 242:3 285:19results 21:3 25:14,16

32:1 33:3 34:14 35:538:1 57:6 60:14 82:784:14 86:6 100:3106:6 109:6 132:6171:17,19 204:21205:8 210:18 212:1223:19 231:19 232:8240:4 248:5 273:19274:11 276:3 285:4296:15

retained 74:13retention 292:3retrospective 114:7return 138:14reveal 105:22 287:18revealed 288:6reversal 209:15 285:22reversals 268:6reverse 197:4 208:7,18

209:5 210:13 234:1258:10 266:2

reversed 197:6 228:9reverses 197:2reversible 207:8reversing 208:13 230:6

284:4


342

review 9:19 10:18 11:1312:1 14:14,16 20:1824:2,8,11,14 25:2226:8,10,11 30:1441:11 52:2,5,7,1664:16 69:14 72:2277:7 85:3 94:5 105:1137:13 151:20 168:19170:13 171:6,18172:11,13 203:6204:12 205:6,13218:15 219:17 220:4240:1 248:14,20262:1 268:12,19269:1

reviewed 24:6 25:1135:2 52:18 93:6 98:2102:17 139:16 140:21241:11 268:18

reviewing 9:14,1725:19 35:20 155:10267:20

reviews 14:10 17:9 36:149:10 51:10,18,2252:11 64:22 82:388:22 89:13 129:5,17167:16 186:15 220:2220:10 248:14 268:21298:3 307:3

revolve 189:17Reynolds 3:1 284:1,2rheumatoid 210:14riboflavin 185:19rice 168:3 179:8,12,16

226:9 280:3rich 249:21Richard 1:17 150:4Rick 37:5,6,19 63:20

69:12 90:1 91:18 96:2112:10 123:18

Rick’s 92:2 100:8 115:8rid 210:8right 10:20 20:5,9 41:21

46:4,14 49:17 56:1457:13 58:7 61:1665:17 66:13 67:8,1768:15 89:8 90:1896:13 97:4 99:1100:19 103:15 106:3106:20 112:19,22114:20 115:6 129:5136:11 191:19 192:13195:18 211:9,20216:20 217:4 230:8256:12 277:8 303:21305:1

rigid 269:10rigor 119:4,7

rigorous 9:18 77:14121:22 170:13 228:22267:16 268:15 269:15284:8

Rip 198:3rise 164:4 235:18risk 21:9 25:5 28:13

29:10,18,22 33:934:11 36:3 38:16 77:979:17 82:10,21 84:384:15 85:9,12 86:1,696:9 120:7 127:12144:4,6,9 162:9 174:8178:14 181:15 190:14192:5 201:1,4 207:12207:19 208:1,1,5221:21 222:5,11,13222:18,20 223:16225:5 234:16 248:2,3248:17 249:8 250:16251:17,21 252:14253:18 256:16 257:12258:4 288:10 295:21296:2

risking 236:7risks 141:11 146:6roast 160:12robust 9:18 195:12

205:5 283:18role 63:1 141:15 151:2

151:13,15 154:19155:5 158:17 161:16164:16 167:17 173:19174:1 183:11 193:19205:9 212:18 218:16218:20 247:8 261:20270:15 271:16 280:5296:22 300:10

rolling 124:21rolls 56:14Ron 69:10Ronald 1:12 4:12room 49:8 69:4 136:14

137:21,22 252:3Rosner 231:4round 11:1 13:7 107:6ruined 231:20run 265:19 294:1Running 286:15rural 118:22

SSabaté 1:19 38:14,14

39:13,13 59:18,19109:5

safe 139:18 142:7155:19 159:21 165:9179:8 230:1 233:18

233:21 290:7 291:20295:10

safely 198:13safer 158:12safety 160:4 161:14

164:18 168:10 235:19292:11

sake 221:14salad 226:9salami 160:13sales 148:8 254:8salmon 60:22 128:20salt 131:13 159:19

168:9 259:17 260:18280:12

sample 37:10,13 39:9100:2 101:2

samples 37:21 82:17sampling 74:17San 200:15sandwiches 261:9Sarah 2:6,7 169:14

179:22sarcopenia 21:4,16

35:16,16 36:4 181:16184:16

sarcopenic 154:16satiated 267:5 283:5satiety 168:2 228:4saturated 28:8,9,10

33:14 124:22 125:3125:10,16 177:14185:7,12 213:14225:1,3,6,10,16 226:1226:5 245:12 247:16251:14,18 257:6,11260:6 268:14 274:18274:20 275:6,12,16275:19,21 276:16,18276:22 277:2,9280:13 281:18

sauce 225:22sausage 221:20sausages 160:13save 198:4 199:13,13

211:12 212:5 217:12288:3

saved 216:1 265:12savings 202:3saw 7:13,13 9:16 42:3

54:18 56:11 57:5175:18 190:5 198:10227:18 228:21 244:10244:11 269:3 281:21

saying 58:1 107:15110:18 132:5

says 96:5 115:16 231:6233:19 262:4 267:10

306:18SC 23:3scaffolds 294:1scaled 273:16scales 31:9scared 254:13scenario 157:17schedule 136:10schizophrenia 191:22Schmidt 2:15 230:19,20Schmier 287:22Schneeman 1:9,11 4:5

4:11 13:14,17 19:1619:20 20:5 42:1446:17 48:9 53:1360:18 64:8 66:6 68:1468:20 106:22 108:1109:4 135:17 302:19305:11

school 135:4 171:8176:18 187:7 189:13194:14,15,21 210:3224:8 232:12 238:13250:9 259:22 294:9294:10 296:7

school-aged 187:8schoolchildren 237:7schools 176:19 224:10

286:13 296:9science 11:13 23:16

117:6,6 142:6 161:13162:1 171:9 176:10188:7 190:21 191:9191:15 192:7 201:19228:22 233:4,6,10,17241:11 255:22 258:13259:5 261:17 262:4264:2 267:20 268:9274:22 282:10 283:16289:11 290:3,6 291:5291:17 293:2 296:19301:4,10 302:15

science-based 5:17121:22 155:19 176:12

scientific 5:16 6:5 9:139:18 10:4 11:20 24:236:5 89:14 116:10,12116:15 119:4,6 122:6131:16 136:5 137:11144:22 150:1 159:2170:9,11 171:11,13171:17 172:12 178:11180:14 182:1 192:22193:3 194:2 195:22196:21 197:14 199:3232:11,21 233:5,9248:14 254:14 267:16270:1 284:17 297:6


343

300:19scientist 202:17 212:14

300:3scientists 130:7 169:17

171:8 182:16 232:17234:3 235:13 239:13239:13 241:16 261:3280:4 285:7 292:16299:8

sclerosis 197:5 210:14scope 25:8 54:14 91:22score 26:21 30:14,22

31:4,10 124:15,16,17124:19 247:12,14

scores 29:16 30:1631:10

scoring 41:3Scott 6:8scourge 296:4scratch 53:4screams 122:13screen 38:20screened 21:1 25:18

26:2,7 72:17 77:12screening 20:22 21:1

25:13 36:5 77:15266:17

sea 235:18seafood 15:20 28:15

40:10 41:2 124:3177:22 197:4 239:8,9240:15 261:17,21262:5,9,12,16,21,22263:5,12,16,20

search 21:3,5 25:1326:3,9 72:1,15

searched 26:1searches 25:17 240:12searching 26:5season 209:3seat 138:14seatbelts 295:10seats 230:17,17second 6:17 10:15

12:19 46:16 68:9 70:874:9 85:21 96:4121:16 147:3 164:10175:11 177:20 188:8193:3 194:1 245:16251:22 255:3,14

second-largest 263:15Secondly 143:14Secretaries 14:18Secretary 5:9 6:1,19

11:4 13:10 308:8section 17:4,16sector 7:21secure 176:15

security 170:15 171:15237:20

sedentary 156:12 157:3157:18

see 6:13,16 8:11 11:915:4,10 16:2 20:1346:10 50:4 55:6,13,1756:7,18 71:14 77:1582:9 86:3,16 96:2199:9 109:6 121:11123:1 127:19 138:6189:22 191:15 192:1206:12 212:1 221:6232:15 235:18 240:10240:11,17,19 244:12244:13 272:7 285:1287:14 297:3,16

seed 275:9 276:21277:7

seeds 65:11,18 143:5170:17 245:4 263:12276:7,10 296:14

seeing 14:22 34:21308:15

seeking 140:1seemingly 227:22seen 21:21,21 24:12

39:10 90:11 144:13171:3 191:18 231:2273:14 274:12 282:12282:16,17

segment 30:13,15segments 109:16 110:2select 65:17,18selected 43:15 237:4selection 92:7selenium 185:17self-control 227:14Self-feeding 279:6self-reported 90:3Senate 215:17send 208:21 305:21sends 147:1senior 239:13 253:6

269:22sense 57:13 60:17 93:9

115:10sensitive 178:15 243:6sensitivities 254:3,5sensory 279:5sent 242:18 307:20separate 45:18,18

72:13 74:1 96:19 97:197:17 153:9 236:13255:12 284:16

separated 242:14September 78:7 171:16serious 123:20

seriously 137:12139:11 211:15,22

serve 160:1 166:15268:5

served 166:16 198:1224:10 226:9 281:11

service 1:8 7:10 182:10277:19

services 5:10,13 6:8,1012:15 37:1 145:21217:8 234:15 292:15

serving 143:15 185:16279:19

servings 145:1 201:9201:14 202:1 229:11255:15 262:11

session 10:16 17:21137:7 138:20

sessions 18:3set 7:17 18:3 23:15

39:10 51:4 62:4 69:397:10 111:17 112:4177:2 189:3 258:12278:7 285:8 286:13

setting 153:13 259:22seven 31:2 158:7

175:13 207:3 214:15264:11 265:13 266:3

Seventh-Day 233:1Seventy-two 186:12severe 35:16 235:17severity 130:9sex 295:11shake 42:7shallots 260:11share 59:15 163:1

200:2shared 42:12shares 162:11Sharon 1:15 126:10she’s 136:19Sheet 297:10shelf 160:10 161:9shelf-stable 280:17,22shift 115:17 193:9

236:17short 41:5 68:19 174:12

230:15 283:17short- 236:21shortfall 181:17 201:10shot 260:22shouldn’t 181:10

276:18show 29:9 34:10 38:20

164:2 165:8 168:11196:21 207:15 259:20289:1

showed 32:14 93:18

247:10 248:14,21268:1

showing 126:15 191:9255:19

shown 47:11 153:17183:22 185:3 207:7207:12 208:6,17219:14 295:18 298:11301:1,10

shows 93:11 164:20166:15 184:5 197:15207:18,21 219:2225:3 257:22 260:10260:20 264:2 297:6301:4,14

shy 11:22sick 210:6 228:19,20

229:14 295:2sicker 199:10,11 211:1

230:4side 137:21,22 230:8

281:8 287:5 293:10sign 210:11 304:9

305:22 306:19signed 299:6 308:7significance 38:8 76:15

96:1 173:16significant 8:19 10:19

27:20 35:5 37:12,1538:1 79:8 81:10 85:1996:6,16 97:5 100:7142:1 150:18 164:2176:2 205:16 248:11248:15 285:17

significantly 174:21175:3,20 204:22245:20 247:17

signing 306:15signs 258:10silver 301:15Silverman 2:7 176:8,9similar 52:4 101:4

106:13 116:18 165:13177:6 226:2 240:14248:5,21

similarly 100:18 133:12simple 189:18,19,22

201:21 228:6 287:21289:15

simplified 47:8 48:6simply 151:4 159:11

195:17 209:9single 74:11,16 75:5

195:17 251:2 307:22single-ingredient

300:16sip 214:12sit 138:14


344

situation 110:13six 27:9 72:17 76:17

77:18 79:21 80:582:17 155:13 229:11232:10,19 233:5282:7 298:2

six-year 84:8Sixteen 31:7Sixty 296:17size 21:5 36:7 37:11

38:8,13,15,18,20 39:939:14 54:21 73:2077:9,17 79:17 81:8,1181:15,18 82:1,20 95:995:11 100:2 101:2106:11 222:17

sizes 37:10,14,21 55:18147:6 159:16 163:5163:13 271:2

skills 279:3,8 307:13skip 91:7skipping 92:3 111:18skyrocketing 207:4slashed 242:19slaughterhouse 242:18sleep 116:21 231:12slide 25:10,12 34:21

36:19 42:3,4 95:1396:5 100:3 110:18

slides 14:4 305:9slightly 59:19slows 147:13small 11:10 32:18 37:14

38:2 63:9,13 99:15100:2 105:11 118:21119:12 132:4 145:18

smaller 6:15 38:1159:16 163:5,13

smaller-portion 164:9smaller-sized 272:7smart 119:17 175:10Smigel 3:3 293:11,12smiling 232:4smoked 160:7smoking 295:9,10snack 205:11 278:22snacking 73:4 92:4snacks 74:21 87:11

91:8 113:2 203:18205:21 271:2

SNETSELAAR 1:19117:21

so-called 286:16social 110:5 204:8society 180:1,2 224:12

226:15 271:10socioeconomic 87:22

120:9 169:4 193:20

291:15soda 122:19sodium 40:5 131:13

161:4 177:14 225:1225:16 226:1 245:12247:16 252:11,15260:2,13 263:13301:13

soil 235:2sole 154:6solely 168:20 219:11

280:13solid 131:2solidified 195:13solution 191:14 195:20

229:21 277:21 288:16solutions 189:19

252:20 292:21solve 8:2 290:4Somebody 109:4somewhat 100:21

135:9sort 17:2 19:21 53:16

54:14 58:6,14 63:1764:12 66:12 67:9 93:7100:1,11 102:3118:11 119:1 122:13124:21 125:3 126:12131:5

sorts 61:19 92:1sound 118:5 302:15source 60:6,10,17

143:15 146:4 154:6161:7 166:11 173:20185:17,18

sources 31:19 58:12140:2,18 143:18151:8 165:10,11,14174:6 177:18 181:20182:8 250:1 252:15

soybeans 143:3 145:8spaghetti 226:11span 181:13spare 265:20speak 44:9 47:8 48:7

114:21 137:17 138:4155:15 224:5 258:22262:1 287:10

speaker 69:6 138:3,9speaking 183:4special 128:1 212:20,22

228:7 236:14 270:10279:1 298:4

specialist 266:13specialists 130:7specialize 209:15specific 18:3 24:18

28:22 31:7 34:1 61:6

65:3 107:16 112:14128:3 129:10 130:21130:22 143:7 153:13154:20 155:2 167:3173:7,10 225:18245:9 252:13 267:13

specifically 6:7 28:1130:10 50:18 61:1392:15 173:3 193:5201:13 236:16 237:1256:17

specified 65:22 224:22specify 44:11 48:1spectrum 52:13 79:22speculative 156:14spend 123:19 261:16spending 10:18 108:13

199:11 294:14spent 71:22 293:21spices 259:18,20 260:1

260:4,17spina 178:21split 143:10spoke 53:9 230:20spondylitis 231:20sponsored 175:11spoon 277:14,18 278:6

278:11,19,20 279:4sports 273:13spot-on 42:13spout 279:12spreadsheet 41:22springboard 166:16stability 235:20stabilizes 288:17stable 275:12staff 12:20 13:6,22 14:1

20:21 21:8 36:4,20,2138:19 46:18 89:17138:2,4 169:20 198:8240:2,7 299:18 303:5303:9,10 306:22307:4,20 308:1

staffs 148:20stage 73:5 128:3 135:3

153:10 184:13 193:21209:19 291:14

stages 134:9 153:8167:18 168:5 177:3193:10

staggering 229:7stamp 123:10,11stance 199:9 276:12

280:8stand 13:7 102:4

241:19 282:9standard 105:3 242:7

242:22 269:2 286:14

standardize 150:7standards 151:12 194:9

196:3 219:16standby 273:10standpoint 55:21 57:9

113:7,19stands 236:8Stang 1:20 64:19,20

107:12staple 167:10 179:5starchy 62:15,20 63:1

166:19 167:13 246:7start 18:7 19:7 40:18,18

53:21 55:7 56:1689:21 107:7 120:15122:17 128:13 136:8137:21 200:1 211:9

started 11:18 13:1414:4 58:20 102:9122:22 228:3 231:12240:3 275:8

starting 58:21 95:17103:11 127:8 136:16136:21 153:5 215:7260:16 262:7

starting-solids 278:1starts 54:15 55:12

60:17 297:19state 6:11,14 215:17

216:20,21 217:2221:17 264:12 265:2

state-of-the-art 267:21stated 146:14 163:9

170:2 186:9 188:12278:15

statement 22:9 82:16217:6 225:2,20246:13

statements 19:1 65:1365:22 226:2

states 6:15 146:3174:21 193:8 195:4203:20 206:18 207:2225:20 250:15 252:9298:20

stating 209:9 247:3statistical 76:14 96:1

119:9statistically 27:20

37:15 100:7 176:1Statistics 298:9status 14:5 16:16

120:10 127:12 160:17168:12 180:22 193:20212:20 213:1 248:13248:17

stave 237:11stay 147:14 306:18


345

steadfast 148:6 302:14steady 266:1step 88:21 124:7 153:3

193:10 232:12,13,13289:15

steps 10:21 36:2212:17 232:10,18233:5,6

stepwise 25:19sterile 280:18 281:4steroids 209:21Steve 69:7,9 89:20

93:21 97:14 100:3Steven 1:16 4:10steward 300:2stiffer 258:3stifle 141:19stifles 182:14stigma 140:8stomach 147:13Stoody 18:11 304:19,20

308:6,13stop 196:20 199:4

210:16 265:8 282:20stopped 231:13stopping 279:10stops 98:4store 65:20 133:17straightforward 189:16strained 238:9strategically 107:6strategies 72:2 130:12

196:6strategy 72:15 183:3

271:4street 1:8 256:13streets 237:8strength 54:21 157:13

180:7 182:1 300:13stress 236:5strips 222:4stroke 83:4 197:17

207:13 220:1 288:12strokes 294:4strong 33:7 104:3

114:22 115:6 154:9191:21 216:5 257:7295:16

stronger 95:12 99:9150:12

strongest 55:6strongly 65:12 162:5

189:4 270:14 278:19280:1

structural 119:14structure 272:16struggled 71:17struggling 231:5 287:1

student 9:1students 8:12,16 240:7studied 55:5studies 15:7 22:8,13

25:11 26:19 27:2030:3,4 32:4,8,20 33:137:9 43:2,6,10,15,1843:21 48:13,20 59:765:10 72:11 73:11,2274:2,3,5,10 75:4,8,9,975:17,20 76:5,7,877:1,17 78:6 80:7,1180:12,15,16,17,2281:6,9 82:4,12 83:8,983:10 84:11,16 85:3,586:4,17 87:1,7,10,1487:16,20 91:2 92:3,2195:21 97:20 99:1102:13 103:5 104:22106:6,7,14 111:17,17112:5 117:4,10,14,19118:17 124:13 144:3144:10 153:17 158:11159:2 167:3 168:19171:15,18,22 173:3173:21 186:15 188:13191:1 218:6 219:18220:9 233:8 236:21246:5,8 247:7 254:13259:20 261:20 268:16274:12 284:17 288:6289:1 295:17 298:10301:1

study 15:7 23:17 26:1231:5 46:22 61:1873:20 74:7 75:1976:14 78:17 79:1,3,780:5,8 81:3,21 82:282:13 83:13,14,18,2284:6 85:10,11,21 86:787:21 93:17 95:5 96:598:16 99:9,16,16100:19 101:12 102:16103:3,3,19,21 104:19116:22 117:9 118:18118:20,21 197:15201:20 222:15,22237:4 245:18 246:11247:9 248:7 249:7257:14 260:9 263:6287:22

studying 212:15stuff 49:15style 66:18 172:2,3sub-cu 106:15subcategory 284:21subclasses 218:17subcommittee 4:6,7,9

14:12 15:10,18 16:6,818:21 19:21 20:1521:11,14 23:5,9 24:1625:7,11 35:9,12,14,2036:18 53:15 64:1068:16,22 111:16113:16 203:6 205:13278:15 304:17 305:3

subcommittees 15:1,519:7 20:2 54:9 107:3107:8 136:2

subgroup 123:22subgroups 59:9 180:20subject 105:13 254:10subjects 82:12 98:16

99:18 101:16submission 165:17submissions 164:10submit 12:1 161:17

283:13 303:19 306:8submits 11:19 14:18submitted 139:16

140:21 155:11 165:6172:15 246:12 299:5

submitting 176:3suboptimal 263:9subpopulations 120:6

120:6 193:2subscribe 111:8subsequent 43:17subset 143:4subsidies 199:6substantial 90:7 208:12substantially 207:12substituted 297:15substitution 174:22substitutions 257:21success 308:9successfully 194:19

228:11suddenly 227:16suffer 199:7 204:1

227:20suffering 211:20

223:17 230:6 287:16suffers 199:1sufficient 153:20sufficiently 133:8

182:12 213:17sugar 15:9,21 40:4

121:16 125:11 149:20163:4,7,7,22 164:6,7164:17,19,22 176:16177:13 197:10 226:5247:16 259:17 260:7265:3 270:13 271:20272:2,13,15,20 273:2273:3 281:17 282:18

283:19 285:3 288:17sugar-free 203:2,17

204:13,20,22 205:7205:10,21

sugar-sweetened 57:2163:2 164:3,5 174:18175:1 213:2 263:13299:13

sugars 40:11,22 131:13159:20 174:21 175:21177:19,19 198:14225:16 251:20 252:2252:7 280:12 292:10301:13

sugary 176:18 177:18250:20

suggest 68:14 144:10185:7

suggested 186:18suggesting 279:2suggests 33:7 249:3suitable 302:11suited 302:8summaries 14:22 15:13summary 12:2 31:18

32:3 36:16 69:8 70:2165:18

sums 71:9 294:20sunny 220:20superfood 279:17superior 226:10supermarket 254:4supplements 141:11,17

152:14 154:3,6,10,13155:6 205:4

suppliers 145:21246:22

supplies 149:7 152:15204:2

supply 122:14 176:15235:15 289:8 290:7

support 12:15,21 13:413:6,22 14:1 36:20,21128:17 134:14,15,18139:11 141:5 142:7151:7 153:16 154:20163:16 171:19 182:8182:13,18 183:20184:12 201:8,19202:10 204:17 240:17240:21 247:2 278:5290:17 301:5 303:9303:11 305:14 307:2307:3,8 308:8

supported 165:2 249:9supporter 300:17supporting 225:13

246:13 296:22


346

supportive 126:13supports 100:8 150:6

153:6 162:5 163:21164:12 177:6 203:17297:8 299:16

supposed 286:7sure 10:10,19 17:10

62:17 64:19 76:597:19 123:4 188:6231:7 239:2 294:18303:12 306:1

surgery 153:22surprise 294:6surprised 231:17

240:13survey 139:21 140:4,10

142:4 232:21 233:7survival 210:1survive 209:21 210:6Susan 2:4 158:9sustain 227:7sustainability 170:15

171:14 172:7 292:12sustainable 170:10

171:4 172:4,12 290:7sustenance 108:18Sweden 78:18sweetened 164:12,21sweetener 149:8 150:4sweeteners 149:5,17

150:5,7 152:3 164:16sweetness 272:15sweets 29:2,9 34:3,10swings 265:3switch 231:11switched 32:3 232:5symptoms 214:4syndrome 248:4 264:15

266:2synthesis 32:4 36:11

219:6system 122:17 132:6,9

232:1 234:21 237:12275:15 279:15

systematic 14:10,1417:9 24:8,11,14 30:1464:16 88:22 89:13129:5,17 167:16168:19 171:6 172:13186:15 204:12 205:6219:17 220:2,10240:1 268:21 307:3

systematically 24:2systems 168:14 169:16systolic 83:20 84:2

TT 190:2

table 38:19 134:5 263:2tables 240:12tacitly 195:21tackled 119:16tailor 268:4tailored 184:22 193:13tailoring 178:18take 12:12 31:14 53:14

60:11 61:12 68:1569:1,3 105:7 107:5127:6 136:7 137:11139:9 211:14,22216:15 221:2 230:12230:17 237:8 259:18306:22

taken 18:4 68:19 82:14136:22 230:15

takes 199:9 233:4 276:7288:5

talk 49:4 116:11 118:5128:5 176:21 230:13241:19

talked 123:8 130:9talking 53:16 65:14

68:2 106:14 126:21134:10 135:12 283:4

tap 296:21target 95:11 108:7

163:22 277:1targets 303:15task 12:21 110:5 162:8

171:9tasked 195:15tasks 59:17taste 279:6 292:21taught 257:5TAVERAS 1:20 49:2

51:16 52:17,21 53:2,6100:18 102:21 103:13108:2

taxes 217:8Taylor 2:13 218:3tea 173:4 174:5,8,14,19

175:2,13,22 219:13219:18,21 220:3,5248:22

teach 197:19teaching 225:14teased 42:20technical 183:8technically 55:10 150:5techniques 160:4technologists 289:21

292:16technology 150:19

215:5 290:3 291:5,18Ted 2:21 266:13teenage 126:15

teenaged 300:4teenagers 126:15teens 288:8teeth 203:3tell 12:20 16:18 66:2

99:13 188:17 189:21231:4 259:14 268:9270:7 301:21

telling 108:4 132:16temper 217:18tend 124:4 257:8tended 29:9 34:10 57:6tendons 232:1tens 268:15TERESA 1:14term 133:13 143:8

146:21 150:7 166:20168:11

terminology 142:22143:12 145:7

terms 15:6 45:1 55:7,1858:13 59:1 67:4 68:3101:14 112:10 113:2114:12 124:11 125:18127:11 130:22 131:12131:17,18,22 132:2132:13 150:4 298:13303:16,20

terrifically 266:7test 232:14tested 22:14 179:13

268:15testimony 234:10tests 102:1Texas 1:9 5:5 8:12

196:15 200:15 238:13238:16 244:7 250:8256:12,13 264:10273:14 287:8 293:15294:15 300:6

text 25:20 26:3 64:17texture 160:9 272:16

279:6thank 8:3,15 9:10,12,22

11:6 12:6,13 13:15,1736:16 39:1 69:1089:16 136:21 137:8138:21 142:9,12,16145:12,14 148:22152:1,6,7,11 155:10155:12 158:5,6161:18,20 165:22166:1,3 169:8,10,11169:13,18,20 172:17172:18 176:5,6,20179:19,20 182:21,22186:1,3 189:8,9192:14 196:10,11

199:15 202:9,10,21206:3,9,10 209:11212:7,9 215:8,10217:21,22 220:19,22223:18,20 224:4226:19,20 230:11,18234:6,7 238:1,4 241:2241:5 244:1,8 246:15246:16 250:2,3,5252:20,21 256:2,3,15258:21 259:1 261:10261:11 264:5,6 266:9266:10 269:18,19270:2 273:5,8 277:10277:11,15 281:3,5,6283:21,22 287:3,4289:17,18 293:4,7,8293:10,11 296:16299:15,20 302:13,16302:20 303:5,13304:14,20,20 305:6305:12 306:22 307:14308:11,13,17

thanking 69:11thanks 6:2 40:7 89:18

89:20 94:13 100:17123:16 138:22 244:2300:21 305:2,7306:21

that’s 16:17 34:1837:19 38:11,21 39:144:7 45:7 46:5,15,2147:2 48:18 55:2158:18 59:11 61:1,364:3,7 65:12,16 66:166:11,19 67:8 68:7,869:16 70:9,10,12 71:675:1 81:16 88:15 90:690:8 95:12 96:3,13100:11,12 104:15109:18 112:17 113:14114:9 115:22 117:19119:20 121:5 123:12123:15 124:17 126:21126:22 127:3 128:13128:22 134:1 136:3136:10 186:20 216:12217:1 241:22 262:19275:4 295:6 302:10308:14

theme 58:16 115:5130:18 131:15,21

themes 28:5 192:20theoretical 156:10therapeutic 285:9there’s 11:22 46:20

47:13 50:7 52:2 55:356:2,11 70:11,17 77:5


347

78:8 79:11 80:4 82:1884:15,17 88:5,6 89:890:10,20 98:3 107:15112:14 113:17 118:14119:8 120:3 123:5125:2,4 127:5,11128:6 129:9,11131:15 138:11 156:5160:21 168:10 184:4201:18 207:14,15235:4 241:14 248:11260:9,14 294:22295:5,16

thereof 120:21they’re 10:19 13:3

19:22 20:3,14 44:5,646:1 63:3 64:22 65:1972:5 77:16 112:14123:1 125:4 128:10136:14 187:2 198:20199:7 209:1 217:17221:7 246:4 267:11275:13 294:18

they’ve 20:21 21:141:20 282:20

thiamin 185:17 247:18thing 12:18,19 42:8

56:8,10 58:5 62:1566:9 71:17 120:1,18125:18 129:21 131:1131:4

things 58:13 61:19 65:166:4,10,19 67:2 68:287:5 88:3 90:16 110:6112:9 118:6,14 126:4127:22 131:17,19133:21 217:8 254:16263:11 275:13 304:3307:12

think 11:9 14:20 15:3,915:22 19:6,20 20:1220:16 38:10 41:5,9,942:12,20 43:1,19 47:548:17 50:21 51:6,1551:17 54:14,16 56:1658:15 59:1,10 60:2161:12 62:16,16,2263:4,7,8,18 64:3,966:1,8,9,13,19 67:3,867:22 68:8,11 70:490:14,22 91:18 94:8,995:14,18 96:12,13,1598:7,13 99:16 100:14100:18 103:19 104:1105:1,6,14 106:8,18107:9,13,13,17,17108:3,18 109:9,14111:8 112:10,12,17

112:18,21 113:4,6,12113:14,18 114:8,12114:17,21 115:4,22116:2 117:2,5,18118:1,7,8,15 119:4,20119:22 120:5,15,19121:19 122:12,22123:7,15,21 124:6,9125:2,13,15 126:7127:1,7,13 129:1,7130:14,15 131:1,14132:15 133:19 135:11135:14,18 136:3,7,9200:6 218:4 240:16246:10 259:10 260:22261:2,8 265:15 271:4293:17 294:12,13295:1,3,5,6 305:1,5

thinking 50:5,14 61:2262:5,7 71:22 81:1390:9 107:19 114:12116:18 117:15 118:2119:5 120:20 121:8124:12 126:11 128:13128:19 131:22 132:20133:2,5,13 134:2136:1 302:22

third 70:12 147:11165:4 178:17 246:1252:10 255:5,18260:7

thought 14:19 46:1049:16 51:5 54:7 70:288:3 92:21 114:11117:20 267:8 286:2307:22

thoughts 114:15118:10 122:4 126:9

thousands 210:13228:14 231:18 268:16273:20 276:10 285:21

three 70:6 71:6,7,1072:19 73:16,19 74:1275:11,12,21 76:1,1980:13,16,17 81:785:14,20 88:12 91:894:14 95:22 97:398:13 99:19,21102:10 106:7,13113:22,22 137:17138:6 141:5 144:13144:17 145:3,10,15155:22 156:15 168:8187:16 190:13 201:2201:8,13,14 202:1210:2,9 221:1,2232:14 235:9 236:13247:20 251:10 254:16

255:10,15 262:11272:18 277:18 278:9288:1 294:17

three-day 72:6 80:1683:14 98:1,9

three-meal 99:19 100:6three-ounce 185:16threshold 284:14,19thresholds 28:22 34:1

285:12thrive 154:15 302:13throats 242:19thrombosis 83:4throw 195:21tie 41:8tied 230:3ties 266:15Tiffany 3:2 287:7tight 40:2Tim 42:14 48:9,11

130:13 305:5time 6:21 8:17 9:6,9,13

10:1,6,14,19 11:2212:17 17:22 18:1,3,622:7 23:9 24:18 35:1249:8 50:7 59:20 69:270:11 71:22 74:9,1175:18 77:13 78:1682:15 91:4,10 102:11102:22 104:7,16105:8 107:2,5,13112:16 120:3 123:10123:11 130:1 134:22137:19 146:19 169:19170:1 176:3 186:1212:7 214:22 220:12226:19 230:13 237:5238:7 246:15 252:11261:17 264:12 265:13273:9 283:14,17293:21 294:15 305:1306:5

time-restricted 117:16timely 302:22timer 138:6times 30:20 70:20

90:20 94:16 97:3110:20 111:2 112:14211:13 219:14 235:9266:5 272:18

timing 17:20 70:13,1371:11,12,15 73:6,1373:18 93:22 94:2,5,694:9 109:10 112:19113:10 138:5 153:3305:1

TIMOTHY 1:18tiny 287:2

tired 264:16tireless 12:15titles 25:19,22today 7:9 8:6,14,16 9:1

9:11 11:9,16 12:914:22 16:5 17:2019:13 21:11 24:772:22 77:7 107:4116:4 130:16 138:12152:12,20 166:5170:7 172:8 176:21177:4 186:7 200:2202:22 203:16 209:7218:9 220:18 224:5225:7 234:18 241:17251:12 254:4 256:15256:16 258:22 259:6262:3 265:15 270:4275:3 277:16 294:16295:12 301:3 308:15

today’s 14:4 180:12toddler 280:16toddlers 25:7 141:15

183:13 278:17tofu 226:8told 190:10 214:9

227:10tolerated 178:13Tom 2:16 238:12tomatoes 292:7tomorrow 172:9Tony 2:13 215:13tool 81:1 164:13 225:14

298:19tools 72:4,5tooth 204:4,6toothpastes 205:3top 57:14topic 62:14 69:22 70:3

70:5,10 71:1 73:777:22 82:3 93:2105:17 112:19 171:7297:4

topics 11:14 64:1 77:16268:12

tortured 229:1total 24:17 91:3 135:3

151:2 157:6 163:10163:22 247:15 274:3

totality 91:9 108:6totally 62:14toxic 214:13 276:4

277:6toxicology 239:15track 16:19 82:12 104:7

146:22 272:11trade 145:18 162:3

246:20


348

traditional 269:13traditionally 10:3 174:3traditions 271:15tragedy 244:18train 129:4training 294:10trans 176:15 245:12

250:19 275:5 280:13transcripts 305:19transform 291:18transformative 283:1transition 135:2 236:15translate 81:15 251:5

262:13translated 120:16 194:4translates 60:1translating 261:18translation 93:12transparency 307:8transparent 165:20

169:22 239:20 281:1travel 12:8 218:9traveled 9:1treat 271:18 272:5

273:6treating 293:21treatment 46:21 186:16treats 271:20 272:3tremendous 111:11trend 85:17,17 95:20

96:16,19trends 55:14,16 104:2

164:2trial 26:14 80:6 95:2,8

98:20 99:12 100:5117:12 220:11 269:15284:9 286:15

trials 37:11 43:20 46:755:5 63:22 88:5 94:1894:20 97:16 99:3,5118:1 131:4 173:22191:1 233:16 258:11268:15,21 283:18286:14 295:18

Trichopolou 30:22Triglycerides 228:10trigs 266:2triple 221:9trouble 68:11true 92:10 98:10 108:9

212:2 229:15 232:15269:14 283:6 286:21

truly 101:22 198:18214:11 294:7

trumps 130:21trust 211:4trusted 228:17trustworthy 267:18

truth 286:5try 17:22 51:15 58:22

76:12 81:20 116:1122:17 227:20 306:13

trying 41:8,22 42:182:12 91:18 92:10134:18 135:20 195:18211:12 229:19

Tuma 2:9 192:16,16turkey 160:12turn 12:11 13:12 53:14

89:22 138:19 274:8304:19

turned 73:11Twelve 210:6twice 97:3 103:19two 5:4 13:11,14 18:9

20:1 25:18 50:2,2070:14 72:5,11 73:1074:1 75:7,18 77:1980:12 81:9 83:8 85:385:11,20 88:13 95:2297:17 99:18,21 107:4127:5,22 138:1 141:1142:13 143:19 144:19146:16 157:8 166:13173:2 177:1 184:11186:8 192:19 194:5198:3 203:22 207:14207:17 213:16 214:9217:8 220:1 232:13232:18 233:6 234:3235:12 239:8 255:1262:8,11 272:18285:13 287:14 303:7304:16 305:6 308:1

two-day 14:9two-tail 101:22two-thirds 194:20,22Tyler 2:16 234:9type 21:6 29:1 34:2

36:8 52:10 60:5,9,1664:4 77:10 85:1,2,985:13 86:1,12 96:9115:11,16 117:19120:7 123:5 184:7187:14,18 200:16,20201:4 215:14 222:3227:17 237:2 244:14245:21 253:19 263:8279:14 286:1 296:3

types 24:5 67:2 72:1175:7 83:4 84:14115:20 125:3,16130:7 147:6 173:10235:5 257:4 268:11296:3

typically 75:18

typo 95:16

UU.S 5:14 62:16 80:8

83:11 85:6 88:1108:12 124:10 132:8139:9 144:17,20146:13 147:3 156:2166:7,8 170:20171:18 172:1,1,3181:7 183:5 200:21231:8 234:13 243:2262:16 263:8,20270:6 273:1 288:2

UIC 202:18ultimate 114:20ultimately 127:18

186:20ultraprocessed 168:17unable 155:7 267:3uncouple 71:15 73:10undefined 87:20under-studied 70:17underconsumed

143:16 257:9underlying 58:14

194:16undermined 242:2undernutrition 154:12underscore 140:4

192:20underscores 290:11understand 6:16 67:4,9

67:19 80:20 120:11128:8 140:11,19190:17 200:11 215:4216:4 252:10,21271:5,19,21 274:20304:8

understanding 89:6127:2 161:13

understands 10:11273:2

understood 70:18undertaking 11:10undertook 171:9underutilized 271:4underway 21:11unethical 243:10unexpected 102:4unfortunately 109:8

132:4 144:18 200:16262:22

unified 166:7unifying 58:16 130:17

131:14,21Unilever 172:21 175:11

218:10

Union 169:16 171:7unique 127:22 128:9,15

145:9 200:11 270:10271:14,16

uniquely 302:8unit 91:4United 146:2 174:21

193:8 203:20 206:18207:2 236:10 237:16250:14 252:9 298:19

units 241:1 243:5University 8:5 48:11

130:14 155:15 212:13212:15 218:7 223:2238:13 250:8 256:14

unknown 82:11 84:1686:8 87:20 156:9

unmotivated 192:2unnecessary 243:11unpopular 275:4unprecedented 237:5unprocessed 197:1,13unrefined 245:3 258:8unsaturated 28:8 33:14

251:15unsurprisingly 259:5unsustainable 207:5unsweetened 173:4

174:5,14,19 175:2,22untreated 204:1unwell 229:4up-front 246:1upcoming 140:6update 17:1 52:22 53:5

172:14 195:5updated 73:15 306:18updates 4:6 14:6 17:7

17:15updating 17:3 150:16

171:6 205:17 307:9upper 157:6 284:19upside 242:19urge 146:12 157:21

165:10 172:10 177:16180:21 215:1 221:16226:6 287:11 290:14295:12

urges 168:18 177:20292:13 298:4

urging 299:10USA 234:11 284:2,5

285:5USDA 6:6 9:19 11:20

12:13 16:13 36:22117:3 142:3 148:21153:7 162:11 169:20175:5 188:12,19194:8 199:1,9,13


349

202:21 205:22 212:19224:6 253:20 280:11299:18 303:10 307:4

USDA’s 5:7,9 7:10182:9 223:14

use 49:12 50:8 81:1989:12,12 92:14,15105:11 131:3 140:16148:7 161:10 205:21225:14 233:4 259:7261:5 275:20 280:8280:17 285:10 292:10

useful 15:22 16:12,1318:14 19:3 20:6135:18 146:4

uses 105:18 298:20usher 138:3usual 138:12usually 37:6 62:16utero 129:6utility 120:20 149:16utilization 157:10utilize 143:12utmost 182:4

Vvalid 102:5validity 90:3value 62:18 67:5,19

164:19 240:22 273:1variability 29:11 146:20

147:5variable 100:13variance 32:22variants 95:20variations 30:21varied 39:7 48:22variety 22:2 27:17 28:3

62:20 106:9 150:20151:8 166:17 194:10201:12 213:3 224:20249:21 259:17 278:11279:17 291:19

various 73:5 120:5132:10,11 181:20193:17 218:16

vary 38:15 39:5,9160:16

varying 43:3,8 159:11vast 147:4 193:6 285:1

286:22vastly 228:10vegan 197:7,22 245:16

245:19vegetable 62:15 166:16

166:19 167:10,14168:22 177:12 249:14280:2

vegetables 28:6 33:1255:11 60:22 62:2063:1 65:11 66:15 67:1110:16 124:5 130:2151:22 166:17 167:2170:16 174:12,17177:9 194:11 197:12203:4 210:17 211:6215:9 219:9 224:20226:9,17 228:4 245:4246:7 249:16,22250:18 258:16 259:21263:12 280:11 281:17296:14 302:2

vegetarian 156:1245:17,22

vein 133:12venous 83:4verify 272:11versatility 169:2version 47:8 127:1

203:15versions 124:6versus 60:2,2 80:12,13

85:20 88:17 95:2297:3 99:20 102:10106:15 110:21

veterans 187:12,15viable 233:21vibrantly 300:14vice 1:12 4:12 69:6

89:20 93:17 103:16105:4 106:3,20125:14 134:3 162:1253:6 269:22

victory 283:3view 18:13viewing 1:10 33:2views 217:19 250:6violence 243:8violently 276:2virtually 254:8visible 39:17visit 9:1visits 231:3 287:18visual 59:17visually 59:13vital 173:14 296:22vitally 180:13vitamin 141:11 167:20

184:10 185:18,22201:15 247:18,19,19253:17 292:9

vitamins 143:16 166:11184:2 278:3 280:19302:5

voice 166:7voluntary 88:17 148:10

162:15 179:6 239:17270:11

volunteer 10:11 59:15volunteered 10:13

59:16vulnerable 120:13

298:12

Wwaist 81:4wait 181:11waiting 136:17 138:4waitlist 137:19Wallace 2:13 218:2,3want 9:22 10:10 12:12

12:19 14:5 19:8 42:742:10 44:9 50:1553:13 54:4 63:6 66:266:3 68:4,9 69:589:15 97:6,21 99:2106:17 108:9 127:7127:20 129:7,8 137:8169:18 186:7 190:17200:1,2 208:21220:22 231:3 264:10281:8 300:12,14303:5 307:15

wanted 64:8 76:5123:17 190:5 198:15265:4

wanting 121:9wants 267:13warming 235:12warn 235:13Washington 6:20

169:17 220:18 253:8266:14 308:16

wasn’t 22:10 61:14,1461:18 91:13 92:1796:20 97:19 102:11102:18 103:8 111:20114:3 227:13

waste 161:10watch 9:2 229:15water 70:21 87:5,6

88:10 104:11 147:14159:19 165:1 180:18203:15 204:2 225:9235:3 248:9 255:2296:20,21 297:2,4,7297:10,11,13 298:1298:14,16,18,22299:4,13

way 7:13 17:5,10,1441:2 54:14 58:1559:11,20 67:9 108:17110:10 111:6,12114:22 115:11,17

130:5 135:6,11,16149:19 155:6 191:22195:1,1 201:9 242:21259:15 260:14,19279:20 296:14 303:13

ways 16:21 26:16 41:17118:18 119:8 158:1158:11 181:21 250:13259:18 261:4

we’d 43:19 138:8192:20 269:16 307:21

we’ll 9:2 13:21 14:2116:6 18:20 20:2 24:752:22 53:5 64:4,568:17 72:21 77:788:22 89:12,21124:16 127:2,19129:16,17 137:21138:22 148:22 161:20169:12 172:19 175:16176:3 182:22 186:3189:9 196:11 199:15202:12 206:5 212:10215:11 217:22 221:1221:2,2 223:21226:20 230:13,16241:5 244:3 246:17250:3 252:22 253:3261:11 266:11 273:9281:7 293:9 299:20302:17 305:20 306:1306:11 308:14

we’re 7:4 8:11 9:9 14:2215:13 17:18 18:721:22 26:13 35:7,740:13 41:8,16,22 42:142:11 45:13 50:5 53:453:4 58:20 64:12 68:168:2,6 69:2,15,1689:7 105:6 108:16,20112:20 113:9,12,13113:17 118:6 124:15126:12,20 134:14,15134:17 135:11,14136:7 137:14 266:7269:17 304:3,8

we’ve 18:12 42:3 53:556:16,20 58:17 63:2166:11 67:3,18 70:971:3,17 72:12,18 88:3104:3,15 113:4,5,12114:18 116:7 130:1134:4,10 172:14237:4 240:14 241:17260:19 274:12 281:9303:7,8 304:5 306:5307:7,15

weak 86:7 254:13 268:3


350

weaning 197:20wearing 295:10weather 235:17webcast 1:10 8:9 11:6

18:1webinar 306:11website 16:16,17 17:2

17:16 18:10 240:5304:2,11 306:14

websites 148:14week 49:17 144:14,17

144:20 145:3,11198:6,9,10,14 201:20262:9,12 272:19

weekdays 74:15weekends 74:15weekly 282:12weigh 49:8weighed 78:18weighing 49:6weight 63:10 77:8,8,20

77:21 78:2,3,11,14,1579:2,9,14 80:1,1,293:12 101:22 128:3146:5 149:12,18157:1 164:13,17165:2 183:22 184:6191:8 192:4 198:15227:7 245:20 246:3248:1,13,17 257:2267:3,7 281:22282:17 288:16,17297:14

weights 106:16welcome 5:3 6:3 238:15

256:14well-being 204:10

297:7 298:7well-known 146:6Welland 2:18 246:18,18wellness 253:13 301:20went 38:17 95:21 96:20

210:3 266:2 303:12weren’t 50:2 98:8

123:11 190:20what’s 37:19 71:20

105:15 106:21,22211:16,18,19 304:12304:12

white 28:22 29:6 34:2,7143:10 159:7 161:17167:1,7,19 197:10

who’s 191:20whole-food 273:17

296:11whole-grain 281:16wide 164:8widely 160:16

wider 166:17widespread 109:15wife 265:14 266:6wiggle 7:18willing 8:6 9:5willingness 12:8willpower 227:15wind 53:19wish 163:1 191:3 241:3within-subject 76:7woke 227:17womb 126:19women 59:9 79:3 85:22

100:2 126:1 128:3146:16 147:21 176:22177:6,17 180:10,22206:13 207:21 208:10222:15 235:22 262:8262:16

Women’s 256:13won’t 229:22 274:8wondered 91:12wonderful 7:17 9:6

12:20 13:1,22 50:13wondering 48:11 49:3

51:16word 111:2 259:6,7words 74:15 81:19

111:3 133:9 206:22208:4 285:17

work 7:1,3,15 9:2,10,179:19 10:13 11:2,1312:3,7,12,15 13:2,313:11 14:1,6 16:4,1416:17,19 19:6 20:1821:15 35:8,10,20 36:136:17,21 40:8 41:842:9,10 50:4 53:1162:19 73:8 90:15117:19 120:4,16124:7 125:5 135:22136:1 142:17 145:12148:8,15,20 162:5169:21 183:7 186:1190:6 191:14,18193:5 200:18 206:10240:7,9 241:3 244:6261:15 293:19 299:16302:13 303:11,18,20304:15

worked 42:5 129:14191:16 241:2 304:22

workforce 135:4working 15:2,5 17:11

19:2 41:20 89:2128:12 129:17 130:6190:10 199:20 203:8227:13 287:8 293:14

299:17works 5:13 131:5,7,11

131:11 192:3 217:14229:21 295:9

world 153:3 154:8222:1,6 226:14234:11 285:7 298:15

world’s 199:7 290:5worse 236:1 282:6worsen 282:1worst 235:5worst-case 157:17worth 100:4 165:5worthwhile 14:19wouldn’t 36:20 100:13wrap 305:11 308:14Wrigley 202:17,19

204:17write 278:10writes 197:21writing 176:4 261:2written 12:1 111:7

142:11 169:9 175:17177:1 186:2 256:1

wrong 227:13

X

Yy’all 256:14 263:14Yael 231:4yeah 38:4,6 39:12,19

42:7 45:11,16 46:148:10,17 50:21 51:251:13 53:8,10 54:359:18 61:20 62:11,1368:21 69:5,17 90:691:7,20 94:13 96:7,1596:17 97:4,8 99:17104:1,17 105:14107:12 118:9 295:3308:13

year 11:18,20 154:17206:14 212:16 227:5227:5 236:14 239:12241:9 242:10,11263:18 288:8

year-round 291:22years 34:19 53:7 74:7

84:3 101:15 116:14124:14 153:19 171:3177:1 178:10 189:22190:9,16 191:21199:20 200:14 203:22207:17 209:18,21210:2,6,7,10 214:16216:1 221:13 227:21228:21 230:22 231:3

231:18,20 232:1234:2,5 238:19,19,19244:10,11 253:21264:11,14 265:13272:6 274:13 275:5,9276:11 277:15,18278:7 281:11,14282:7 287:9 293:15294:14 307:17

yesterday 9:16 14:2115:4,18 18:12 53:964:10 68:4 89:7 107:4108:10 109:22 114:16116:4 122:13 128:18130:10 193:18 240:13240:18 260:20 261:8268:1 269:3 306:3

yielding 74:22yields 235:19yogurt 125:6 201:12York 212:14 215:14,17

216:21you’d 138:15you’ll 11:9,11 18:8

71:14 77:15 82:9138:5 214:20 240:10240:11,19 308:3

you’re 6:13 18:8 49:555:3 57:22 74:7 81:1281:12 95:3 103:17123:13 138:13 193:5195:15,17 216:14233:12 261:2 266:3295:2 304:11 306:14

you’ve 21:20 24:12 42:890:11 104:7 107:8303:3

young 2:2 145:16,17177:17 190:1 193:13

younger 34:18 244:13244:13

Zzero 297:13zinc 143:15 184:2

185:19Zones 232:22

00.7 262:17

11,000 260:3 283:91,200 139:211,693 26:11.27 263:171.5 216:221:00 17:21


351

1:02 137:110 35:4 38:16 77:14

80:13 101:15 108:13124:14 163:22 169:12207:3 213:21 231:20247:11 252:4 263:9284:22

10-minute 226:22230:12

10-year 82:1 103:1910-year-old 101:1310:30 68:16,18100 37:9 99:21 186:20

233:16 247:3,10,22248:12,14,21 249:13249:16,22 275:8276:11 282:11 290:1

105 26:21106 4:11107,000 192:1811 172:19 306:1111,547 25:221100 1:8113,000 21:212 139:22 176:7 202:2

229:9 262:11 267:3286:8 288:3 298:2

12-week 79:10120 266:713 4:5 164:11 165:17

179:21 239:13 299:7130 189:2 265:10133 188:21 193:15136 4:1314 146:18 183:115 27:9,15 76:6,11

186:4 207:22 208:2210:6,10 259:22

15-year 164:2150 191:20152 26:10,1116 189:10 209:18 287:916,000 289:2217 192:1517,775 307:7173 228:818 196:12 222:51830s 300:819 153:19 199:16190 21:101990 268:20

22 21:6 36:8 77:10 85:1,2

85:9,13 86:1,12 96:9115:12 120:8 184:7187:14,18 197:15200:16,20 201:4

215:14 227:17 237:2244:14 245:18,21253:19 263:8 279:14286:1 296:3

2-1/2 217:62,000 101:162.5 263:22:00 18:62:40 230:1220 4:7 74:7 162:22

178:10 187:9 199:20202:13 203:17 216:12219:14 221:13 222:16231:13 259:22 264:14283:7 300:22

200 38:2 227:22200,000 222:152000 78:7 171:202005 144:162005-2010 203:122010 268:222013 163:8 264:112014 162:19 163:12

215:20 287:222015 35:20 146:13,19

155:20 157:22 163:21166:14 170:12 171:11171:16 172:13 177:8184:21 185:21 203:15237:22 247:21 262:10269:8 277:10 295:15297:1

2015-2020 224:16290:16

2017 272:4 277:202018 257:162019 78:7 139:20 142:4

171:16 247:10 248:7248:13 263:6 278:3285:8

2020 1:1,5 6:4 13:12141:1 142:5 147:3153:5 158:3 180:5183:9 186:9 255:12266:19 267:10,14280:22 284:11 290:10297:4,17 299:19302:14

2020-2025 169:6 270:162025 6:42025-2030 181:9 195:142030 288:82050 235:1220s 190:821 147:21 202:14

222:1822 164:11 171:18 206:6

248:2

23 190:16 209:12230:22

24 1:5 15:19 25:8 31:888:12 180:9 205:2212:10 278:14 281:14297:18

24-hour 74:13,16 75:1175:12,22 76:2 94:798:13 111:22 112:1

24,000 216:1 217:1225 38:17 181:15 188:20

189:22 200:13 203:22208:10 215:11 216:10229:16 233:20 244:10244:11 274:2 284:18285:2 307:17

26 218:127 27:6,14 221:3 248:328 205:2 223:22 238:1929 215:20 226:21

33.2 262:203:40 230:123:57 308:1830 14:8 30:17,20,21

76:8,11 201:16230:14,18 275:5281:11 282:9,16285:14,15 287:17

30-34 208:11309 4:1530s 157:931 234:832 238:1133 241:634 244:335 34:18 246:1736 250:437 252:2238 253:439 256:3

440 219:17 231:14 234:1

256:6 272:19 286:17288:7

400 165:941 32:18 259:241,000 72:1641.7 32:1842 261:1243 264:744 266:1145 23:20 99:18 137:18

188:13 216:11 269:20273:17 274:7 284:14286:17

46 273:1048 277:11 298:1548% 187:1849 281:7

55 4:2,3 254:750 207:18,20 213:18

222:12 265:10 282:16285:15

50-percent 260:1251 281:8 284:651,000 77:1352 281:953 283:22532 6:14554 26:256 287:557 289:1858 293:1059 296:17

66 146:18 217:460 207:9 208:5,6 232:4

260:6 274:5 298:1160,000 231:260s 181:1661 299:2262 299:665 23:19 153:9 187:19

260:6 298:565,000 183:569 4:9

77 18:16 19:2 303:197,000 180:270 153:19 199:6 201:15

266:770s 282:12

880 30:1680s 282:1385 39:4 146:286 259:988 229:7

99 164:119.5 263:39:00 1:99:02 5:290 213:19 300:790s 282:1394 200:895 39:4 139:8


352

97 289:1,3

COURT REPORTERS AND TRANSCRIBERS 1323 RHODE ISLAND AVE., N.W.

(202) 234-4433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com

C E R T I F I C A T E

This is to certify that the foregoing transcript

In the matter of:

Before:

Date:

Place:

was duly recorded and accurately transcribed under

my direction; further, that said transcript is a

true and accurate record of the proceedings.

-----------------------Court Reporter

353

Public Meeting

2020 Dietary Guidelines Advisory Committee

01-24-20

Houston, Texas

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